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9ONITORING WELL INSTALLATION REPO <br /> Date: !/% �� CONSTRUCTION <br /> Premise Address: S6� °� ( �` � Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from)-(to)- <br /> Inspector: <br /> from) (to)Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist - T <br /> ABOVE-GACUND CMAISTY 80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sutac+ <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft, <br /> If yes, location and distance - <br /> tt n. <br /> _ m <br /> SAMPLING donad = E <br /> soden <br /> Holding Temperature = Gr+ G <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) Y <br /> n. = tt. <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 />