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S./ <br /> MONITORING WELL INSTALLATION REPO <br /> CONSTRUCTION <br /> Date: 6 /� <br /> Premise Address: 7 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: � / Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector: w Drilling rig type <br /> Auger O.D. I.D. . <br /> Permit No. Completion - Stove pipe/chrisde box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller' T height <br /> ir6' <br /> Consultant A - . - T <br /> Geologist Ag7CYE,-5RCUN0 ck�t:STY B4X <br /> COI+FLETfOH C*MPL_EMN <br /> Ground Suiacs <br /> SPECIAL.PERMIT INFO. <br /> pra t <br /> Distance to server line `It, <br /> Domestic well on site .- (y/n) tt- <br /> If yes, location and distance - — <br /> O <br /> SAMPLING tocicn = <br /> Holding mp ra e 00r. = F <br /> .z <br /> Method <br /> Screenin;Method <br /> /fi} _ <br /> Tracking ft.. <br /> Sheet <br /> SPOILS <br /> MATERIALS IJVEI.OPMENT <br /> Storage Method <br /> Contamination Noted- (y/n} Casing type ft.S <br /> Storage Location BIft Screen <br /> Slot size <br /> Bags cement <br /> GROUTING UTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/n) <br /> installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of rncthod <br /> EH 29 29. <br />