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-MONITORING WELL INSTALLATION REP( <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: casing <br /> height <br /> _q <br /> Consultant T <br /> Geologist T <br /> ABOVE-GROUND C.NRLSTY-SOX <br /> COMRLETJOH COMFLEnON <br /> SPECIAL PERMIT INFO. Ground Sw1we <br /> Distance to sewer line 2(cut <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft. <br /> pp r <br /> SAMPLING <br /> sadcn <br /> Holding Temperature <br /> _ grgvw ack <br /> Method _ ! <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS EVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUCING Bags cement <br /> Buckets bentonite <br /> Depth to water - 1 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 />