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MONITORING WELL INSTALLATION REPO <br /> Date: ` CONSTRUCTION <br /> Premise Address: l� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. ' Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller. <br /> �� .6 ;scasing <br /> eight <br /> Consultant <br /> Geologist <br /> ASCVE-GROUND C-sm Y-8CX <br /> CC&F R3CN CCMP' -7CN <br /> SPECIAL PERMIT INFO. GraLod Siafacs <br /> Distance to sewer line Qrout <br /> Domestic well on site - ( y/ n ) . <br /> If yes, location and distance - <br /> _ <br /> SAMPLING slca d = <br /> sacscn <br /> Holding Tempgrature = gavel ,ack <br /> Method <br /> Screening Method ICA <br /> Tracking Sheet / n ) _ <br /> :Y. ♦ _ ♦ }L <br /> SPOILS <br /> Storage Method MA=ALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist-. ( y/ n) <br /> Type of method <br /> EH 29 29 <br />