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A <br />( �NITORING WELL INSTALLATION REPOI <br /> Date: CONSTRUCTION 4 <br /> Premise Address: �S Total Depth <br /> Screen Length (from) (to) <br />,f Well No.. Filter Pack {from) (to)--—{ <br /> Bentonite (from) (to) <br /> Inspector: Grout (fro (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. 2 F <br /> Completion - Stovepe/cluistie bo (circle one) <br /> Drilling Company: �`t <br /> Driller• �'� J _ casi_ng <br /> height <br /> Consultant ��1yN8r1 �, .� <br /> T <br /> Geologist ,/� y T <br /> ABOVE-GRCUNO CHR M43OX <br /> COMPLETION CCMPLETICN <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line �f0� <br /> Domestic well on site - {y/ n) <br /> If yes, Iocation and distance - ft. p i <br /> Ip <br /> SAMPLING <br /> secdcn = <br /> Holding Temperature gra <br /> Method _ t <br /> �: <br /> OCK <br /> Screening Metho <br /> Tracking Sheet - (y/ n ) A — <br /> SPOILS <br /> t Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y. n } `r lq/� <br /> Storage Location Casing type <br /> .� Blank fL Screen- <br />( Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel _ <br /> Mix Ratios =T r Filter Pack type/size <br /> Installation Method Surge Block: - (y n ) <br /> Quantity Installed Discussed with geologist: / n <br /> Type of method <br /> EH 29 29 <br />