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MONITORING WELL INSTALLATION Wtwd <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/christie box (circle one) <br /> Drilling Company: <br /> Driller casing <br /> height <br /> 11MTGeologist- <br /> ABOVE-GROUND G{MM_wx <br /> OWLEMN COMPL EMN <br /> SPECIAL P R T TWO. GrCUM SLOwe <br /> Distance to sever line <br /> Domestic well on site {y/n) 1 M <br /> If yes, location and distance - tL <br /> a.R w <br /> SAMPLING "� s <br /> Holding Temperature vN <br /> Method Pack <br /> Screening Method _ <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIW EVELO MENT <br /> Contamination Noted- {y/n} <br /> Storage Location Casing type <br /> Blank fL 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 />