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OONITORING WELL INSTALLATION REPO <br /> Date: <br /> Premise Address: CONS—ON <br /> Well No.: Total Depth <br /> Screen Length (from) <br /> Inspector: Filter Pack (from)--�(to)--- <br /> Bentonite (from)--�(to)--� <br /> � <br /> Permit No. Grout (from)-- �(to) <br /> Drilling rig type —(to)= <br /> Drilling Company: Auger O.D. <br /> P y' Completion - Stov pipe/christD bo�— <br /> Driller: <br /> (circle one) <br /> Consultant casing <br /> height <br /> Geologist <br /> ABOVE-GRCUND <br /> SPECIAL PERMIT INFO. C'ONFLETION CHR 'Y-BOX <br /> Ground Saixe C <br /> OMPLETICN <br /> Distance to sewer line t — <br /> Domestic well on site Crart <br /> If yes, location and distance - <br /> ft. <br /> eft. ft. <br /> _ a <br /> = m <br /> e <br /> SAMPLING <br /> slotted <br /> Holding Temperature sect.on <br /> Method = V1 vac <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 water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method <br /> Quantity Installed Surge Block: - ( y/ n ) <br /> Discussed with geologist: - ( y/n ) <br /> EH 29 29 Type of method <br />