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i..,,oNITORING WELL INSTALLATION REPO]" <br /> Date: �� CONSTRUCTION <br /> Premise Address:—S-?- b'�t Jam' Total Depth <br /> '/ Screen Length (from) to) <br /> Well No.: t T Filter Pack (from) to) <br /> Bentonite (from) (to) <br /> — <br /> Inspector: 68'6 Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I. <br /> Completion - Stove pipe/chri 'e box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> Neigh • <br /> Consultant <br /> Geologist <br /> ASUVE-GROUND CHRiM-SOX <br /> CaMPL.E'r*N COMPLETION <br /> SPECIAL PERMIT INFO. rho ird Sw1we <br /> Distance to sewer line groat <br /> Domestic well on site- (y✓n <br /> If yes, location and distance ft. <br /> _ m <br /> m <br /> G <br /> O <br /> SAMPLING slotted C <br /> sectcn <br /> L <br /> Holding Temperature _ W pwk <br /> Method V2 — <br /> Screening Method ' — <br /> Tracking Sheet - (ya/ n} A' <br /> SPOILS <br /> Storage Method MATERIALS EVELOP NT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank Screen ft• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite r <br /> Depth to water4/S Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />