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i <br /> --)NITORING WELL INSTALLATION 1. . ORT. <br /> C ONSTRU CTI ON <br /> Date: <br /> Total Depth (to) <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite' (from) (to) <br /> Grout (from) •(to) <br /> Inspector: Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No.• Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> ' � casing <br /> height <br /> Driller: • <br /> T _ <br /> Consultant •� <br /> Geologist �BOVE�ROCJtlD G,�i15iY BOX <br /> OOWPLET}ON COMPL.ETiON s <br /> C3tou r�5 urf x e <br /> SPECIAL PERMIT INTO, Grout <br /> Distance to sewer line h, i <br /> If yes, location and distance <br /> e <br /> Z to tied V2 <br /> Sp,N1PLING , <br /> 9-v-{ Pack <br /> Holding Temperature _ <br /> Method <br /> Screening Method - <br /> Tracking Sheet - (y/n) _ .�► <br /> tt. tt. <br /> SPOILS <br /> • Mp,Tg�AIrS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/n) Casing type <br /> Storage Location Blank---.ft Screen ft <br /> Slot size <br /> Bags cement <br /> GR_O�NG Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter packtype/size <br /> Mix Ratios <br /> Installation Method Discussed with geologist: - (y/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 " <br />