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gONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: 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 /> Drilling Company: Completion - Stove pipe/cluistie box (circle one) <br /> Driller: <br /> „ — casing <br /> Consultant � height <br /> Geologist <br /> ABOVE-GACUND G4i1STY 80X <br /> OOWLETICN CCMPL°TICN <br /> SPECIAL PERMIT INFO. Groundgulxy <br /> Distance to sewer line Or1as <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> • tt. <br /> ft. <br /> — m <br /> SAMPLING ` <br /> 0 <br /> aloCnd = �c <br /> aoc'cn '- <br /> Holding Temperature <br /> Method = pava yadt <br /> a = <br /> Screening Method J”, <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 /> EH 29 29 Type of method <br />