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MONITORING WELL INSTALLATION RET <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from)—(to)- <br /> Bentonite <br /> from) (to)Bentonite (from)—(to)- <br /> Inspector: <br /> from) (to)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 T <br /> Geologist ._'al T <br /> ABOVE-GROUND CNAISTY BOX <br /> COMPLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfsn <br /> Distance to sewer line ofOLf <br /> Domestic well on site - (y/ n ) 1 ft <br /> If yes, location and distance - <br /> tt ft. <br /> m <br /> _ <br /> = c <br /> SAMPLING slatted - c <br /> on = <br /> Holding Temperature <br /> Method = D <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 bfT G AlelS/§vl <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 />