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• '--MONITORING WELL INSTALLATION REI,--.cT <br /> Date: ! ! CONSTRUCTION <br /> Premise Address: 20 L& Total Depth <br /> Screen Length (from) (to) <br /> Well No.: f/U C Ivy Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: i 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 /> r/ height <br /> Consultantt > 1 <br /> Geologist •- <br /> ABOVE-GROUND CHR*'rY-BOX <br /> CONFLEC1ON COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surf=s <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft• <br /> �• ft. <br /> SAMPLING slotted <br /> sedan , <br /> Holding TemperaturegmvW= p <br /> ack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ft. ft. <br /> SPOILS <br /> Storage Method MATERIALgZPEVELOPMENT <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 `F3_ 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 />