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MONITORING WELL INSTALLATION REPP�^T <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 Q.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant IrIT <br /> Geologist 7— 1.9 <br /> ABOVE-GRCKJND <br /> COMPLErION Ci-IMM-BOX <br /> COMPLE MN <br /> SPECIAL PERMIT INFO. Ground Surd <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) ft. <br /> If yes, location and distance - <br /> ft. <br /> #t. <br /> Y� m <br /> a4 � <br /> SAMPLING � — w <br /> siottad <br /> ^. <br /> mon <br /> Holding Temperature �= <br /> Method � "" Fave,Pack <br /> Screening Method -= <br /> Tracking Sheet - (y/ n ) YK <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 /> 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 />