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IONITORING WELL INSTALLATION REPO <br /> Date: Wm CONSTRUCTION <br /> Premise Address: i37 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from)—(to)- <br /> Bentonite <br /> from) (to)Bentonite (from)—(to)- <br /> Inspector- Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/clu-istie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant6 <br /> 4.T- —Geologist <br /> ABOVE-GROUND <br /> COMPLETION CHAISTY-BOX <br /> SPECIAL PERMiT INFO. Grourd g%rfycy COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) �_ft. <br /> If yes, location and distance <br /> • tt. <br /> tt. <br /> �A O <br /> V <br /> SAMPLING doral — c <br /> soc'cn <br /> Holding Temperature = <br /> Method = FsvdG <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 /> EH 29 29 Type of method <br />