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VONITORING WELL INSTALLATION REIT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Inspector: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (cir <br /> Driller. <br /> casing <br /> Consultant ,a <br /> height <br /> Geologist ja-7 Z` <br /> ABOVE-GRCUND T <br /> COMPLETION CHRZTY-SOX <br /> SPECIAL PERMIT INFO COMPLEitCN <br /> �—•���Ground Sudan <br /> Distance to sewer line orout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> SAMPLING = c <br /> Holding Temperature +ectcn <br /> Method = pacx <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) r? <br /> SPOILS <br /> Storage Method <br /> Contamination Noted • (Y/n ) MATHRIALS/DEVEI OPMENT <br /> Storage Location Casing type <br /> Blank ft. Screen h. <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed Surge Block: - ( y/ TI—) <br /> Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />