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�--x iONITORING WELL INSTALLATION REPOh�f <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 pipeJchristie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant T <br /> Geologist •- T <br /> ABOVE-GROUND <br /> GOMPL_LT4N CHRISTY480X <br /> COMPL-=nON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> t. <br /> If yes, location and distance - ffL <br /> ti. <br /> SAMPLING ttottad — <br /> wclon — <br /> Holding Temperature : <br /> ack <br /> Method �` P <br /> Screening Method ' <br /> Tracking Sheet ( y/ n ) <br /> ft. <br /> LE- <br /> SPOILS = <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing type <br /> Blank ft. Screen ft- <br /> SIot 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 />