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MONITORING WELL INSTALLATION REPO• + <br /> Date: <br /> CONSTRUCTION— <br /> Total Depth <br /> Premise Address: <br /> Screen Length (from) (to) <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. <br /> Completion - Stove pipe/duisde box (circle one <br /> Drilling Company: <br /> casing <br /> Driller: ��� height: <br /> Consulcan[ T <br /> Geologist ABOVE-GRCUND otiR:STY-Box <br /> ooMPLETION cowL_- ICN <br /> SPECIAL PERMIT INFO. *l + <br /> pram <br /> Distance to sewer line RZ <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - n• <br /> tt. _ <br /> = o <br /> c <br /> — o <br /> ilonad � <br /> SAMPLING 4 c "– <br /> Holding Temperature <br /> Method <br /> Screenin;Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location Blanc ft Screen h• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water <br /> Filter Pack type/size <br /> Mix Rados <br /> installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 . <br />