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N MONITORING WELL INSTALLATION REPOnf <br /> Date:- l0 ��� CONSTRUCTION <br /> Premise Address : Total Depth <br /> C �(� /C Screen Length (from) (to) <br /> Well No. : C' 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 /> Consultant <br /> i <br /> Geologist <br /> ABOVE-GACUND CHA1STl'43OX <br /> COMPLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Swine <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) 1 <br /> If yes, location and distance - "— fto <br /> ft. <br /> ft. <br /> SAMPLING slotted = ' <br /> season <br /> Holding Temperature = gravW Pack <br /> Method = _ <br /> Screening Method = <br /> Tracking Sheet - ( y / n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type <br /> Blank It, 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 />