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'MONITORING WELL INSTALLATION REP <br /> Date: r ���1 _ CONSfRUGTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (frons) (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 /> Consultant------- —EWT <br /> Geologist —rl <br /> A80VE-GROUND CHRfS'1'Y-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SUrlwe <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) 1 ft, <br /> If yes, location and distance - tL <br /> it. <br /> �* Cr <br /> w r <br /> SAMPLING elo6d <br /> ercion <br /> Holding Temperature <br /> Method Pack <br /> Screening Method <br /> Tracking Sheet (y/nIF <br /> } '•: <br /> ..�...�� <br /> n <br /> SPOILS <br /> Storage Method MATERUU S/DEVELOPMENT <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 />