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-ONITORING WELL INSTALLATION REPC <br /> CONSTRUCTION <br /> Date: <br /> Total Depth <br /> Premise Address: Screen Length (from) <br /> Filter <br /> o} — <br /> Filter Pack (from) <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) <br /> Inspector: Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: ilm height <br /> 'f <br /> Consultant T <br /> il <br /> Geologist Al� -GRC-UfgO C4-S*TY-BOX <br /> coNFLE CN COMPL=_MCN <br /> Ground Surface <br /> SPECIAL PERMIT INFO- <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) tto <br /> If yes, location and distance - <br /> b <br /> C <br /> O <br /> SAMPLING •lorr+d c <br /> s�cticn � <br /> Holding Temperature 71 Pal* <br /> Method =' <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) a: - <br /> - fta <br /> SPOILS <br /> Storage Method MATERIAL�ELOPMENT <br /> Contamination Noted - ( y/ n ) Casing type <br /> Storage Location Blank ft- Screen ft. <br /> Slot size <br /> GROUTING Bags cernent <br /> Buckets bentonite <br /> Depth to water Bags sand/gravO <br /> Mix Ratios___ Filter Pack type/size <br /> aton Method Surge Block. - ( y f tl ) <br /> Installation <br /> QuantityInstalled Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />