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t, <br /> ..,IONITORING WELL INSTALLATION REPO.-- <br /> I <br /> Date: CONSTRUCTION <br /> Premise Address: 99V 1r,444 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> �y Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipelchristie boat (circle one) <br /> Drilling Company: <br /> ® a <br /> Driller: ~� casing <br /> height: <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO, Ground Surface <br /> 1 <br /> Distance to sewer line 7196grout <br /> Domestic well on site ® (Y <br /> if yes, location and distance - ;pl� ti�� Amok&a - <br /> SAMPLING <br /> on r;' <br /> Holding Temperature <br /> Method v <br /> j Screening Method <br /> Tracking Sheet (y n <br /> I SPOILS <br /> Storage Method — MATERIALSIPEVELOPMENT <br /> Contamination Noted - (y n) ' go � <br /> Storage Location Casing type <br /> Blank .5ft. Screen to ft. <br /> Slot size ,01-0 <br /> GROUTING Bags cement_ <br /> Buckets bentonite 4 etc--- _.,:,., <br /> Depth to water - Bags sand/gravel <br /> Mix Ratios Filter Pack type/size Ib <br /> Installation Method Surge Black: - (y I n) <br /> Quantity Installed Discussed with geologist: - (y 1 n ) <br /> Type of method <br /> EH 29 29 <br /> l �f� <br />