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%,wJNITORING WELL INSTALLATION REPO <br /> Date: /t l i CONSTRUCTION <br /> Premise Address: �� �' """"��` Total Depth <br /> Screen Length (from) (to) <br /> Well No.: fGl/• Filter Pack (from) (to) <br /> Bentonite (from) (to <br /> Inspector: Grout (from) (to <br /> Drilling rig type r" <br /> Permit No. Auger O.D. �_ LD. <br /> Completion - Stove pipe/cluistie box circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist '� T <br /> ABOVE-GACUND CHRZ rY-BOX <br /> COMPLETION COMP=ON <br /> SPECIAL PERMIT INFO. Ground 5ufxt <br /> Distance to sewer line praut <br /> Domestic well on site - (y ) (a f!> <br /> IF yes, location and distant - ff. <br /> SAMPLING <br /> 6. — <br /> HoIding T7pmperature ti <br /> Pack <br /> Method { A- <br /> Screening Method + <br /> Tracking Sheet y n ) <br /> SPOILS ����s'i <br /> Storage Method S rtec MATERIALS/DEVELOPMENT <br /> Contamination Noted - C y/ I <br /> Storage Location e Casing type PVA <br /> . <br /> Blank � ft. Screen Z ft. <br /> Slot size '02"0 <br /> GROUTING Bags cement I'L— <br /> Buckets bentonite <br /> Depth to eater �� �� Bags sand/gravel / <br /> Mix Ratios 'Filter Pack type/ e <br /> Installation Method Surge Block: - ( / n ) <br /> Quantity Installed D Discussed wit eologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />