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."MONITORING WELL INSTALLATION REPO e: <br /> Date• b �) ... 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.`Z �� Auger O.D. I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company:_��k <br /> Driller: aas Lng <br /> height <br /> Consultant _qWT <br /> Geologist -- <br /> ABOVE-GROUND CNRtm_soX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Swfaat <br /> Distance to sewer line grout <br /> Domestic well on site - (y <br /> If yes, location and distant - � <br /> gA r <br /> SAMPLING �Ior.A.i <br /> Holding Tem erature c ✓ _ �� <br /> Method _� ?-�t� l — <br /> Screening Method ?/ <br /> Tracking Sheet - j/ n ) <br /> Z '°"M ft. <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 />