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NITORING WELL INSTALLATION REPO(,., <br /> Date: I I CONSTRUCTION tl v C <br /> Premise Address:�:�ps Total Depth J <br /> Screen Length (from) (to) S <br /> Well No.: Filter Pack (from)� (to) <br /> Bentonite (from) (to) <br /> Inspector. a A U A to Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> S ) Completion -Stove pipe/cluistie box (circle one) <br /> Drilling Company: - <br /> Driller: T casing <br /> height <br /> Consultant fA <br /> Geologist <br /> ABOVE-GACUND Ct4 tM43OX <br /> 00kVLETION COMPLEnw <br /> SPECIAL PERMIT INFO. Ground Surfxt <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ ) �_ft. <br /> If yes, location and distant n. <br /> R. <br /> 1 v s r <br /> 0 <br /> SAMPLING ` Q� Boned <br /> I � tedcn _ <br /> Holding Temperature = gmvwpy* <br /> Method <br /> Screening Method V — <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method �LbATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / n) a <br /> l Storage Location Casing type <br /> i Blank ft. Screen �L ft. <br /> Slot size -0 l <br /> GROUTING Bags cement <br /> I Buckets bentonite l tel/ <br /> Depth to water SS Bags sand/gravel <br /> Mix Ratios fa qr�6s� %Filter Pack type/size �-1 i <br /> Installation Method a � i Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n) <br /> i <br /> Type of method <br /> EH 29 29 <br />