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ONITORING WELL INSTALLATION REP( <br /> Date: 6 S 173 CONSTRUCTION <br /> Premise Address:—A94 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <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-GROUND CHAISiY-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line — grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> ro a <br /> [0 ft. <br /> SAMPLING <br /> slotted _ c <br /> 2� asclon <br /> Holding Temperature ( _ gravW Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) 4 __ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) ^ I I pvc," <br /> Storage Location Casing type <br /> ft Screen <br /> Blank 't <br /> Slot size D•t'! <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to waterL— Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - �n ) <br /> Type of method �/ <br /> EH 29 29 <br />