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NITORING WELL INSTALLATION lus 1 <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 <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> CORSUItanC. _EWT <br /> Geologist <br /> ABOVE-GROUND CNAISTY-80X <br /> COtvPLET10N COMPLETICN <br /> SPECIAL PERMIT INFO. G=rd skwef <br /> Distance to sewer line orart <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance- <br /> ft. <br /> — d <br /> = m <br /> = c <br /> SAMPLING dattai <br /> cac9cn <br /> Holding Temperature <br /> Method ' _ <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing type <br /> Blank ft. Screen Ct. <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 /> Installation Method Surge Block: - ( y/n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />