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MONITORING WELL INSTALLATION REPO <br /> CONSTRUCTION <br /> Date: <br /> Total Depth (to) <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) (to) <br /> well No.: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. LD. <br /> Permit No. Completion - Stove pipe/dtristie box (circle one) <br /> Drilling Company: <br /> casing <br /> � <br /> Driller: height <br /> Consultant <br /> Geologist ABOVE-GRCUND c�-s*-ry-BpX <br /> COMPLETION CCMPLETICN <br /> 'o Ground Sufaca <br /> SPECIAL PERMIT INFO. Xi <br /> 'I W Ott <br /> Distance to sewer line <br /> Domestic well onsite - (y/ n) ft. <br /> If yes, location and distance - ti <br /> :yL <br /> — cc <br /> tlorad = ❑ <br /> SAMPLING socicn _ <br /> Holding Temperature �vd F <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/n) Casing type <br /> Storage Location Bl ft Screen —fr <br /> Slot size <br /> Bags cement <br /> GROLMNG Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Rados Surge Block: - (y/n ) <br /> Installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />