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MONITORING WELL INSTALLATION REI;-e-T <br /> Vdile <br /> CONSTRUCTION <br /> Premise Address: - / �'1 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> 'AA LL Bentonite (from) (to) <br /> . 6 "^��'� Grout (from) (to) <br /> Inspector <br /> Drilling rig type <br /> Permit No. Auger O.D. I-D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: r <br /> casing <br /> Driller. /�- � � height <br /> Consultant n <br /> Geologist ABCVE-GROUND <br /> d-RIST`!8CX <br /> COMP+_i,CN <br /> SPECIAL PERMIT INFO. <br /> r � <br /> gtoc.2 <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) --` <br /> If yes, location and distance - dL <br /> - <br /> _ = _ <br /> — o <br /> a <br /> SAMPLING slocted <br /> tacvan J <br /> , <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - / n ) <br /> IL ♦ t tL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank—fr. Screen fL <br /> Slot size <br /> GROUTING Bags cement_ <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist - C Y <br /> Type of method <br /> EH 29 29 <br />