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- NITORING WELL INST TION REPO:. `l <br /> Date: 1. -7 — CONSTRUCTION <br /> Premise Address: I.JLd Total Depth <br /> � r <br /> Screen Length (from) D (to) _ <br /> Well No.: Filter Pack {from) 91 D (to)...3 <br /> Bentonite (from)_ 5'` _(to) <br /> Inspector. Grout (from) 4 {to) <br /> Drilling rig type <br /> Permit No. <br /> bE L� Auger O.D. �'` I.D. <br /> Completion - Stove.pip sne (circle one) <br /> Drilling Company: <br /> Driller: cas i.ng <br /> height .l <br /> Consultant <br /> Geologist -� <br /> ABOVE-GRCUND CHRIS"TY$OX <br /> COMPLETION communCN <br /> gPECIAL PERMIT INFO. Ground Swfaos <br /> Distance to sewer line prou< <br /> Domestic well on site - ft. <br /> If yes, location and distanc --- ft, <br /> ryv ft. <br /> d <br /> SAMPLING :brei c <br /> aoc�cn x.. <br /> S <br /> Holding Temperature grauric . <br /> Method <br /> Screening Method <br /> Tracking Sheet - {y/ n} :; <br /> SPOILS <br /> Storage Method Un L MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n �� (� <br /> Storage Location Casing type <br /> Blank to O ft. Screen, <br /> Slot size )y <br /> GROUTING Bags cement IO <br /> I / Buckets bentonite <br /> Depth to water_,_ �� 3 �- Bags sand/gravel <br /> Mix Ratios - Filter Pack type/size_ i fe <br /> Installation Method Surge Block: - ( y/ n} <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />