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OONITORING WELL INSTALLATION REPA <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) <br /> (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from)—(to)— <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (cirde one) <br /> Driller: casing <br /> height <br /> Consultant 17 <br /> Geologist _ T <br /> ABOVEGROUND <br /> COLiPLETION CHR*TY480X <br /> SPECIAL PERMIT INFO. GroUnd COMPLETION g�{yty <br /> Distance to sewer line Ott <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft• <br /> ft ft. <br /> = m <br /> c <br /> SAMPLING = <br /> 0 <br /> sbttad = $ <br /> tK710n <br /> Holding Temperature <br /> Method = v'"°I Pack <br /> Screening Method " — <br /> Tracking Sheet - (y/ n ) _ <br /> ft• = tL <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 Pact 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 />