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MONITORING WELL INSTALLATION R.L_./RT <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 /> ABC VE-G R CtJN D <br /> CO WF LET C N CMPLETIC X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Suriacs <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - ( y/ n ) <br /> ft. <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> o <br /> m <br /> C <br /> P <br /> SAMPLING <br /> sac�cn <br /> Holding Temperature = P <br /> ack <br /> Method = <br /> Screening Method =_ <br /> Tracking Sheet ( y/ n ) <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 />