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i"` 10ft, <br /> JNITORING WELL INSTALLATION REPO:. <br /> Date: �� I CONSTRUCTION <br /> Premise Address:.-,2"5 0 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> —Erw—f <br /> Consultant IT7T <br /> Geologist •- <br /> ABOVE-GROUND CHRJSTY4= <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer linegrout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft' <br /> ft. <br /> ft. <br /> m <br /> = o <br /> SAMPLING slotted <br /> sacdon = <br /> Holding Temperature .;. <br /> Method gravel Pack <br /> Screening Method = <br /> Tracking Sheet - (y/ n) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <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 />