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%�.,JNITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: oas inq <br /> height <br /> Consultant —VV-T <br /> Geologist -w <br /> ABOVE-GROUND MISTY-Sox <br /> COMPLETION 00MP=0N <br /> SPECIAL PERMIT INFO. Ground Surf <br /> rout <br /> Distance to sewer line Qf <br /> Domestic well on site - {y/ n) 7■it. <br /> If yes, location and distance - n. <br /> ft. <br /> SAMPLING stored <br /> Holding Temperature <br /> Method _ P <br /> �M = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> .a: <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROLMNG Bags cement <br /> Buckets bentonite <br /> Depth to water 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 />