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MONITORING WELL INSTALLATION RET'–%T <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (front) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. E.D. <br /> Completion - Stove pipe/chrisde box (circle one) <br /> Drilling Company: <br /> DrillerT casing <br /> T tteirht <br /> Consultant '4 <br /> Geologist <br /> —QVT <br /> A8CVF--G IC'UN0 CH STY-box <br /> 00WL r;CN <br /> SPECIAL PERMIT INFO. C3rcur�d Sutaca <br /> Distance to sewer line gran <br /> Domestic well an site - (y/ n ) <br /> If yes, location and distance - ft. <br /> _ e <br /> C <br /> SAMPLING =lord <br /> sec:cn _ <br /> Holding Temperature — �,�pack <br /> Method :Z- __ <br /> Screening Method <br /> Tracking Sheet - ( y/ nIF <br /> } # — <br /> #!. ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> BIank fL Screen ft <br /> Slot size <br /> GROUPING Hags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installadon Method Surge Block. - ( y/ n } <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />