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-)NITORING WELL INSTALLATION REPO. <br /> l� 0 V), <br /> Date: CONSTRUCTION <br /> Premise Address: 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 /> Consultant height <br /> Geologist <br /> ABOVE-GAC UND <br /> COh�l.ETtON CNFi1ST'Y-80X <br /> cOMPLEmcN <br /> SPECIAL PERMIT INFO. Ground Sulwo <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) �__ft. <br /> If yes, location and distance - n, <br /> h. <br /> SAMPLING slored <br /> soden <br /> Holding Temperature = gavot Fade <br /> Method _ <br /> r::v — <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 />