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1 ,,JNITORING WELL INSTALLATION REPO., <br /> Date: Q CONSTRUCTION <br /> Premise Address: ���N �"`� ZC�d,C(,Q Total Depth y` TO <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 /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: height casing <br /> Consultant 'T <br /> _EWT <br /> Geologist -- <br /> ABOVE-GRCUND CHR*'Y-80X <br /> CO&V LET*N COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfact <br /> Distance to server line <br /> Ott <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft- <br /> ft. <br /> o <br /> SAMPLING sbt'•a.9 -= <br /> soden " — <br /> Holding Temperature <br /> Pack <br /> Method <br /> Screening Method ? <br /> Tracking Sheet - (y/ n ) <br /> JLSPOILS <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 />