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—MONITORING WELL INSTALLATION REPOTI "T <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 /> Drilling Company; Completion - Stove pipe/cluistie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist <br /> IIBGVE-GROUND <br /> ca�L.Rso a C,4RZTY-30X <br /> SPECIAL PERMIT INFO. Grourd 5uf,ct <br /> cCMPL,mcN <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n } <br /> I;yes, location and distance - }t. <br /> _d <br /> _ m <br /> b <br /> a <br /> SAMPLING � <br /> a[oC:oi c <br /> dOClcn <br /> Holding Temperature <br /> Method __. Vnvd Pack <br /> Screenin;Method <br /> Tracking Shcet - ( y/ n ) <br /> }t. <br /> SPOILS <br /> Storage Method MATEWALS EVE[.OPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GRG=NG Bags cement <br /> Buckets bentonite <br /> Depth to wvater Bags sand/gr;ivel <br /> Mix Ratios _ Filter Pack type/size <br /> lnstalladon Method Surge Block: - ( y/ xl ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Eli 29 29 Type of method <br />