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•MONITORING WELL INSTALLATION REOT <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: <br /> from) (to)Inspector: Grout (from)-(to)- <br /> Drilling <br /> from) (to)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 <br /> Geologist ABOVE-GROUND <br /> COMPLETION CHRZ'ry-Box <br /> COMPLETION <br /> SPECIAL PERMIT INFO. GoundStafact T� <br /> Distance to sewer line oroul <br /> Domestic well on site - ( y/ n ) �_tt, <br /> If yes, location and distance - tt. <br /> tt. _ <br /> M, <br /> a <br /> o <br /> SAMPLING alovad <br /> sacdon - <br /> Holding Temperature = praval pad" <br /> Method ' <br /> Screening Method <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 $. <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 />