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`.ONITORING WELL INSTALLATION REPC`, <br /> 31) CONSTRUCTION <br /> Date: <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: W �Zi ? Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. l 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: r casIng <br /> height <br /> 4 he±qht <br /> Consultant � / 7/1 <br /> �4 �r�—i� <br /> Geologist <br /> ABOVE-GACUND CHR*TY-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sur1>n <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) ft. <br /> If yes, location and distance - ft <br /> tt. <br /> 19 <br /> SAMPLING donai <br /> o� saricn <br /> Holding Tejp ep nature pant <br /> Method <br /> Screening Method _ <br /> Tracking Sheet • (y/ n ) x; <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) , a <br /> Storage Location Casing type L- <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 />