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MONITORING WELL INSTALLATION Rc.PORT <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 /> Consultant <br /> Geologist •- <br /> ABCVE-GACIJND CHRZITY-80X <br /> 00NFLFT10N COMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line <br /> out <br /> Domestic well on site - (y/ n ) �_.ft. <br /> If yes, location and distance - ft- <br /> ft. <br /> w <br /> SAMPLINGM = g <br /> tlorai � <br /> sacicn — <br /> Holding Temperature = Ravi F <br /> OCK <br /> Method = <br /> Screenin;Method <br /> Tracking Sheet - ( y/ n ) — <br /> tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <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 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 />