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MONITORING WELL INSTALLATION REPOn i <br /> i <br /> Date: / CONSTRUCTION <br /> Premise Address1�� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: l Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> q Drilling rig type <br /> Permit No. O��SI Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> �• _� � � _ <br /> Consultant height <br /> Geologist • <br /> AE 0; E-GROUND CHRLM-BOX <br /> CO MPLEf CN COMPLEMN <br /> SPECIAL PERMIT INFO. Ground Surfaces <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) $ <br /> ft. <br /> If yes, location and distance - ft. <br /> ZZft. <br /> SAMPLING slotted = c <br /> section <br /> Holding Temperature = �, Pack <br /> Method = _ <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 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 /> L <br /> oq <br /> bj <br /> ol <br />