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100NITORING WELL INSTALLATION REPO <br /> Date:_ I <br /> CONSTRUCTION ; <br /> Premise Address: Total Depth Z , <br /> A P Screen Length (from) (to) <br /> Well No.: v Y <br /> ff y Filter Pack (from) (to) <br /> Inspector. d , dt� Bentonite (from) (to) <br /> d Grout (from) (to) <br /> Drilling rig type <br /> Permit No. I n Auger O.D. I.D. <br /> Drilling Company: <br /> �I/� l� Completion - ve pipe stie box (circle one) <br /> Driller:_ casing <br /> V r � Yj height <br /> Consultant V V►U(yr L ' <br /> ABOVE-GROUND <br /> COMPLETION CHR*-rY-BOX <br /> SPEO&PERMIT INFO. COMPLE ON <br /> Ground Sartre <br /> Distance to se r line grout <br /> Domestic well on ' e - (y/n) <br /> If yes, location and ce - 4115� ft. <br /> I U 1, <br /> _ m <br /> 0 <br /> m <br /> SAMPLING alottud <br /> 44c9on <br /> Holding Temperature = <br /> Method _= 9R+�Pack <br /> Screening Method <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Me <br /> Contamination thod oted - y n LOPOP_MATERIALS/DEVELMENT <br /> N <br /> Storage Location Casing a ; �- 40 d <br /> Blank ft. Screen h. <br /> Slot size b 0 yt4 d�l <br /> GROUTING r Bags cement j6I0 <br /> Buckets bentonite <br /> Depth to water L Z" Bags sand/gravel <br /> Mix Ratios l y V Yy Filter Packtype ze V <br /> Installation Method9 / Surge Block• - y/ n ) <br /> Quantity Installed Discussed witWeologist: - (y/ n ) <br /> EH 29 29 Type of method <br />