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GONITORING WELL INSTALLATION REP* <br /> i <br /> 1 <br /> Date: / <br /> CONSTRUCTION <br /> Premise Address: % /t' 7"�� li(�� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> inspector: <br /> Bentonite (from) (to) <br /> �'V�^"� <br /> Grout (from)—(to)— <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> r,2 <br /> casing <br /> Consultant �� t- 1,2 e� height <br /> Geologist Ti <br /> ABOVE-GROUND <br /> COtl1PLETION CHAISTY-BOX <br /> SPECIAL PERMIT INFO. CCMPLEnCN <br /> Ground Sudan <br /> Distance to sewer line oraut <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft, <br /> � ft. <br /> tl <br /> SAMPLING a <br /> slorrd — c <br /> socdcn <br /> Holding Temperature <br /> Method = gavel pads <br /> Screening Method <br /> Tracking Sheet - (y/ n ) " — <br /> :s' _ <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 /> EH 29 29 <br /> Type of method <br />