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dVITORING WELL INSTALLATION REPOT'" <br /> CONSTRUCTION <br /> Date: ,� J <br /> 57 �nti.t. j)"O Total Depth <br /> Premise Address: Screen Length (from) to) <br /> L{ Filter Pack (from) to) <br /> Well No.: 1 Bentonite (from) (tb) <br /> Grout (from) (to) <br /> Inspector: b�'��"'— "` Drilling rig type <br /> .. Auger O.D. I. . <br /> Permit No. Completion - Stove pipe/chri 'e box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: � � Neigh <br /> Consultant <br /> Geologist ABOVE-GROUND atm-Box <br /> OOWL.ET{ON COMPi.EMON <br /> Qroucd Surface <br /> SPECIAL PEItMT INFO. <br /> grout <br /> Distance to sewer line <br /> Domestic well on site- (y I n) ft. <br /> If yes, location and distance44 ft. <br /> 1 •s <br /> �ti b <br /> C <br /> O <br /> slatted <br /> SAMPLING sac ion <br /> 'rel pack <br /> Holding Tem erature .: <br /> Method <br /> Screening Method — <br /> Tracking Sheet - (y�/ n) ; ^ n. <br /> SPOILS <br /> MATERIALS EVELOP NT <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location Blank Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to wate Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ n ) <br /> Installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />