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f <br /> MONITORING WELL INSTALLATION REI--.-T <br /> Date: a� CONSTRUCTION <br /> Premise Address: ' Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) Cto) <br /> Bentonite (from) Cto) <br /> . /X� Grout (from) (to) <br /> Inspector <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion -Stove pipe/christie box (circle one) <br /> Drilling Company: — <br /> casLag <br /> Driller. height <br /> Consultant <br /> �sz r r <br /> Geologists Lj it8CYE3ACtNC) <br /> C}+AtS^!-30X <br /> C,CIVFL STAN COWL-75CN <br /> Sul <br /> SPECIAL PERMIT INFO. 'nd � T--_ <br /> i <br /> prart <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) t <br /> If yes, location and distance - fL <br /> fL <br /> r _: = <br /> S: $ <br /> 0 <br /> SAMPLING ib�d _ <br /> wccn � <br /> Holding Temperature <br /> Method = <br /> Screening Method _ <br /> Tracking Sheet - ( y/ n ) <br /> :t. <br /> SPOILS <br /> Storage Method MATERIAIS/DEVELOPN ENT <br /> Contamination Noted - ( y/ n ) Casing e hc <br /> Storage Location Blank e ft. Screen <br /> Slot size` gn — <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to waterBags sand/gravei <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block - (y/n) <br /> Quantity Installed Discussed with geologisn - C y/ a) <br /> Type of method <br /> EH 29 29 <br />