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)NITORING WELL INSTALLATION REPC <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 /> height <br /> Consultant IV —E <br /> Geologist T <br /> 07/ABOVE-GROUND CHRZTY48ox <br /> COAFLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - ft. <br /> ft. <br /> n <br /> SAMPLING •Ict'a.! = o <br /> sodcn _— <br /> Holding Temperature v: _ vay sl F <br /> acx <br /> Method _ <br /> Screening Method c —_ <br /> Tracking Sheet - ( y/ n ) — <br /> �.ft. <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 />