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GONITORING WELL INSTALLATION REPO <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 /> ConsultantT <br /> —TRW <br /> Geologist ABOVE-GROUND <br /> COMPLETION C <br /> COOMPLMPLY-BOX <br /> IF�.T I <br /> ETION <br /> SPECIAL PERMIT INFO. ��Ground S�'o' + �� <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) n. <br /> If yes, location and distance - tt. <br /> n. <br /> a <br /> _ m <br /> C <br /> SAMPLING slot = g` <br /> axtian <br /> Holding Temperature = gni P� <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y/ n) <br /> ft. <br /> = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DMLOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> gl� 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 />