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MONITORING WELL INSTALLATION REPO <br /> Date: D 1 �0 CONSTRUCTION <br /> Premise Address: <br /> �h�� Total Depth <br /> Screen Length (from)—(to)— <br /> Well <br /> from) (to)Well No.: G/N e Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector: � Grout (from) (to) <br /> Drilling rig type <br /> Permit No. y Auger O.D. I.D. <br /> Drilling Company: N" <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: casing L <br /> height <br /> Consultar <br /> Geologist 1W T <br /> ABOVE-GROUND <br /> 9B OOf.FLETIONPLETION <br /> SPECIAL PERMIT INFO. I Ground Surlact — <br /> Distance to sewer line <br /> a'� r 11� grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - tt- <br /> tt. <br /> = o <br /> = m <br /> = c <br /> o <br /> SAMPLING slattad = `` <br /> aectan — - <br /> Holding Temperature = gravel pads <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method�4d MATERIALS�EVELOPMENT <br /> Contamination Note - (y <br /> Storage Location Casing type <br /> Blank ft. Screen___-----.ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water x fi Bags sand/gravel <br /> Mix Ratios T AWAZ Filter Pack type/size <br /> Installation Method Surge Block: - (y/n ) <br /> Quantity Installed e- Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> 9 Zs -or �w �� (a ' �� <br />