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�.,,,,oNITORING WELL INSTALLATION REPO1 <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 /> Completion - Stove pipe/chrisde box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> he_ght <br /> Consultant 'V <br /> 7/4 <br /> Geologist ABUUKE-GqC(ND <br /> COfv�'t.E7iON G�iASTY-8C3X <br /> SPECIAL PERAT INFO. Ground Surf'cre <br /> gra.K <br /> Distance to sewer line <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - - ft. <br /> �a r <br /> SAMPLING <br /> soc1cri A <br /> Holding Temperature _ pavat�aa3t <br /> Method ` — <br /> �ti — <br /> Screening Method — <br /> Tracking Shcet - (y/n 4. —_ <br /> SPOILS <br /> Storage Method MATEPJ6LSMEVELOPMENT <br /> Contamination Noted • (y/n} <br /> Storage Location Casing ta'p'e <br /> Blank ft. Screen h• <br /> Slot size <br /> GROUTING nags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> 4pstallation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29. . <br />