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-)MTORING WELL INSTALLATION K . ORT ! <br /> C ONSTRU CTI ON <br /> Date: <br /> Total Depth ;. <br /> Premise Address: Screen Length (from)' (to) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite' (from) (to) <br /> Grout (from) (to) <br /> Inspector: Drilling rig typ e <br /> Auger O.D. I.D. <br /> Permit No.' Completion- Stove pipe/chr•istie box (circle one) <br /> Drilling Company: <br /> C9 _ <br /> Driller: height <br /> C ons u1 tant <br /> Geologist ABOVE-GROUND e![RISiY-8OX f <br /> OOWLFf}ON COMPLETION y <br /> C3rours�Surfyce <br /> SPECIAL PERMIT INFO. <br /> p r out <br /> Distance to sewer <br /> ft. <br /> If yes, location and distance- 4 <br /> — n <br /> IL <br /> O <br /> SPZIIIG <br /> ack <br /> Holding Temperature = ��P <br /> Method <br /> Screening Method - <br /> Tracking Sheet - (Y/n) _ <br /> —SPOILS <br /> • MATERIALS/DE�LOPMENT <br /> Storage Method <br /> Contamination Noted - (y/n) Casing type <br /> Storage Location Blank {t Screen ft• <br /> Slot size <br /> GR=G Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter packtype/size <br /> Mix Ratios _ _S,urge_$lock:-C.Y-/—n-) <br /> Installation Method Discussed with geologist: - (y/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 - <br />