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'MONITORING WELL INSTALLATION REPO , <br /> Date: CONSTRUCTION <br /> Premise Address: <br /> Total Depth I <br /> Well No.: Screen Length (from)- 9 ,. <br /> '^� Filter Pack (from) <br /> Bentonite (from) (to) <br /> Inspector: _ Grout (from) (to) <br /> . 4 <br /> Drilling rig type � , <br /> Permit No. k ,. Auger O.D. �- <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: <br /> casing- <br /> height 4 <br /> Consultant <br /> Geologist T w <br /> ABOVE-ORCUND my-sox <br /> COMPLETION <br /> C N - , <br /> SPECIAL PERMIT INFO. G=nd SLOwe <br /> Distance to sewer line grout <br /> Domestic well on site - (Y y n <br /> If yes, location and distance - R- <br /> w t <br /> `.err/ -!•.-^'"_`wi .r xc.. w a +:C.. �• - <br /> SAMPLING alorod ' <br /> w AL..y <br /> soden <br /> Holding Temperature '-LY <br /> Method <br /> F Screening Method <br /> Tracking Sheet (y/ n ) ' <br /> {� �• N I <br /> Yli Ilu w . <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT t I <br /> ` r 3 <br /> Contamination Noted - (y/ n ) <br /> Storage Location r , _ Casing a <br /> x Blank ft. Screen ft. <br /> . - r Slot size <br /> 1 GROUTING .. -., Bags cement <br /> v r ,.... <br /> ..Buckets bentonite S . <br /> Depth to water <br /> Bags sand/gravel <br /> Mix Ratios 'Filter Pack type/siz <br /> Installation Method Surge Block: - (y t ) <br /> Quantity Installed - Discussed with geologist: - n ) }, <br /> Type of method <br /> EH 29 29 <br /> . Y <br />