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OONITORING WELL INSTALLATION REP ' <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) Cto) <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 /> ABOVE-GFCUND <br /> COMPLETION CHMM-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlacs <br /> Distance to sewer line PRI <br /> grout <br /> Domestic well on site - C y/ n ) <br /> If yes, location and distance - n. <br /> n. <br /> n. <br /> SAMPLING = <br /> slatted _ 'E <br /> section <br /> Holding Temperature <br /> Method — gr"`s,'ac,Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> a' <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen fr. <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 />