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C��^✓C n n � -)NITORING WELL INSTALLP.TION REPO � <br /> Date: ,/�rU//// CONSTRUCTION <br /> Premise Address: y r y 3/ le- 'g� 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: cas Lng <br /> height <br /> Consultant -�• <br /> Geologist T <br /> ABOVE-GROUND CHRZ Y-BOX - <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground S�iCe <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft <br /> ft. <br /> a <br /> — c <br /> — o <br /> SAMPLING slatted <br /> . C sec4on '^ _ <br /> Holding Temperature gravel pack <br /> Method I=_ <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 fr. <br /> Slot size <br /> GROUTING Bags cement <br /> / I 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 />