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gONITORING WELL INSTALLATION REPO <br /> Date: t- CONSTRUCTION <br /> Premise Address:_ Total Depth yt <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: ^ Grout (from)—(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_ <br /> Driller: casing <br /> height <br /> Consultant lilF7 4 <br /> Geologist �r�- � �- T <br /> ABOVE-GACUND <br /> —q <br /> COMPLETION CHRIM-aox <br /> CCMPLETICN <br /> SPECIAL PERMIT INFO. L Grourd Sufis <br /> Distance to sewer line oras <br /> Domestic well on site - (y/(p ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> �i <br /> — a <br /> — C <br /> SAMPLING = <br /> 0 <br /> ic <br /> �IOn'c <br /> tocn — <br /> Holding Temperature = ova pads <br /> Method — <br /> Screening Method r <br /> Tracking Sheet - ( y/ n ) <br /> K• -- — fL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type O <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installadon Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />