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ONITORING WELL INSTALLATION REPO* <br /> Date: CONSTRUCTION 1 <br /> Premise Address: Total Depth I `� <br /> Screen Length (from) 1 !, (to) t 11 <br /> Well No.: Filter Pack (from) 1 1 —1 (to) 11) 3 J <<S C <br /> Bentonite (from) og (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type0 ati(etcn <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company. <br /> casing <br /> Driller. <br /> height <br /> Consultant • W'E Geologist ASCV -GROUND C,8 SY-30X <br /> CCAFLL'TICN C„MP!E ICN <br /> SPECIAL PERMIT INFO. Gr=d Strtaca <br /> Ott <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) • ft. <br /> If yes, location and distance - ft <br /> a <br /> - � e <br /> o <br /> SAMPLING sloned <br /> Holding Temperature = gavel pads <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n) <br /> tt • = + a. <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 Bagssand/ <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />