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MONITORING WELL INSTALLATION I.4RRT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: Screen Length (from)• (to) <br /> Piltet Pack (from) (to) <br /> Inspector: Bentonite' (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/chn'stle box (circle one) <br /> Drill ex: casing <br /> Consultant height ' <br /> Geologist <br /> ABOVE-GROUND <br /> COMFLE-nON cFsz-rY-Box <br /> SPECIAL PERMIT INFO. COMPLFIioN <br /> ' C'rwnd Swixa <br /> Distance to sewer line Qro t <br /> Do�nestie is <br /> If yes, location and distance - tt• <br /> ft. tt. <br /> T . <br /> SAMPLING <br /> dotted = c <br /> Holding Temperature +x9on <br /> Method Vis: = w+velpack <br /> Screening Method <br /> Tracking Sheet - (y/n) _. <br /> SPOILS <br /> t <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft' Screen g, <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method __Sjarge_Block_(,y_/na <br /> Quantity Installed __ Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />