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40NITORING WELL INSTALLATION REPIS <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from)_(to)— <br /> Well <br /> from) (to)Well No.: Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector: Grout (from)—(to)— <br /> Drilling <br /> from) (to)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 .WV T <br /> T <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION COO <br /> COMPLETION ON <br /> SPECIAL PERMIT INFO. Ground SAY° + <br /> Distance to sewer line PIZ <br /> grout <br /> Domestic well on site - (y/ n ) n. <br /> if yes, location and distance - n. <br /> n. <br /> = m <br /> — d <br /> = c <br /> — o <br /> SAMPLING slottad <br /> wCion <br /> Holding Temperature = pnvsl 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 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 />