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GONITORING WELL INSTALLATION REPO <br /> Date: 'Wro CONSTRUCTION AAO WAL& <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: leo { Filter Pack (from) (to) <br /> � �/� 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: 't" <br /> i <br /> Driller: casing <br /> height <br /> Consultant rlkA"� �f . _ T <br /> Geologist 4 ti - T <br /> ABOVE-GROUND CHRISTY BOX <br /> COMPL17bN COMPLETION <br /> SPECIAL PERMIT INFO. Ground Su ian <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> ft' <br /> If yes, location and distance - <br /> ft h. <br /> e <br /> o <br /> SAMPLING slotted = 8 <br /> C {�CJon <br /> Holding Tem ature i x,,,91 Pack S � w' <br /> Screeni4Method ; <br /> Tracking Sheet - (y/ n ) : <br /> n. ' = n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing e <br /> Blank ft. Screen ft. <br /> Slot si e <br /> GROUTING Bags mens <br /> Buck is bentonite <br /> Depth to water 1� Bags sand/gravel <br /> Mix Ratios Filt Pack type/size <br /> Installation Method n-tsfi S e Block: - (y/ n ) <br /> Quantity Installed D' cussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 <br />