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MONITORING WELL INSTALLATION REP01,J <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 /> Consultant <br /> Geologist •- <br /> ABOVE-GROUND CtiFiJ5"�Y-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Swlacs <br /> Distance to sewer lineg=am <br /> Domestic well on site - (y/ n ) R- <br /> If yes, location and distance - <br /> O <br /> O <br /> SAMPLING slattad f: — <br /> "Cton <br /> Holding Temperature ;:. : gravel paps <br /> Method <br /> Screening Method ` <br /> Tracking Sheet - (y/ n <br /> ft. ft. <br /> SPOILS <br /> Storage Method MATERIALgZ2EVELOPMENT <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 />