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."ONITORING WELL INSTALLATION REPORv-- <br /> Date: [ 11 CONSTRUCTION <br /> � Gl/. l .� <br /> Premise Address:—// Total Depth ��( 7/ <br /> Screen Length ( omj (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: bov � '1 <br /> Driller: casing <br /> /& height <br /> Consultant C9 •�- <br /> Geologist T <br /> ABOVE-GROUND <br /> COM?LETfON C4iR15iY-BOX <br /> COMPLETiCN <br /> SPECIAL PERMIT INFO. Ground Sumac* <br /> Distance to sewer line - i grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - ID <br /> 1 <br /> 31 — • <br /> SAMPLING - { = o <br /> siottad _ c <br /> on <br /> Holding Temperature <br /> O <br /> Method s - _ gr" Pack <br /> Screening Method <br /> Tracking Sheet ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �G" 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 />