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MONITORING WELL INSTALLATION REPO <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: <br /> Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filter Pack Mom) (to) <br /> Inspector: Bentonite (from)Grout (from) <br /> (from)�_(to)_ <br /> Permit No. Drilling rig type <br /> Auger O.D._�_ I.D. <br /> Drilling Company: Completion - Stove pipe/chrlstie '—box one) <br /> Driller: <br /> casing <br /> Consultant height <br /> Geologist �rr- <br /> ABOVE-aA(DUND <br /> SPECIAL PERMIT INFO. WAFLETION CHRLM-Sox <br /> Ground Sauce C <br /> OMPLEnON <br /> Distance to sewer line * — <br /> Domestic well on site - (Y/n ) grout <br /> If yes, location and distance - <br /> ft. <br /> ft. ft. <br /> m . <br /> SAMPLING = z <br /> slatted — 2 <br /> Holding Temperature sectfon <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y <br /> SPOILS <br /> Storage Method <br /> Contamination Noted - (y/n ) TES DEVELOPMENT <br /> Storage Location <br /> Casing type <br /> BI—__fr. Screen h <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Piter Pack type/size <br /> Quantity Installed Surge Block: - (y/n) <br /> Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />