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`„JNITORING WELL INSTALLATION REPO <br /> Date:___ " y CONSTRUCTION <br /> Premise Address: as L Total Depth o�-5 <br /> Screen Length (from)_ <br /> Well No.: m Filter Pack (from) <br /> �-� Bentonite (from) -; (to) <br /> Inspector: Grout (from) 2— (to) <br /> C / Drilling rig type I <br /> Permit No. d -( Auger O.D. 'Y ' I.D. <br /> ' Completion - Stove pipe/ sae ox ircle one) <br /> Drilling Companyf <br /> Driller• <br /> casing <br /> height <br /> Consultant IV <br /> GTA -qVT <br /> Geologist_ [N M <br /> ABOVE-GRCUND CHM_ <br /> ( COhFLfiT10N COMPLE7ICN <br /> SPECIAL PERMIT INFO. �a- 13 Ground Sumacs <br /> aJN�� <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLINGslorad <br /> T`• — <br /> = S <br /> socycn � — <br /> HoIding Temperature vN <br /> gavel pads <br /> Method c <br /> Screening Method "r = <br /> Tracking Sheet - (y/ n ) <br /> .X <br /> ft. tt- <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n I Q` <br /> Storage Location &Y" Casing type <br /> Blank S ft. Screen ft. <br /> Slot <br /> GROUTING Bags cement <br /> Buckets bentonite r <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 />