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M-INITORING WELL INSTALLATION REPr-"RT <br /> Date: � ) J P CONSTRUCTION <br /> Premise Address: � ^ � L Total Depth <br /> Screen Length (from) (to) <br /> Well No.: N✓ S 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: casing <br /> height <br /> Consultant i/ r� -c f d —QV-F <br /> G -- <br /> ABOVE-GROUND CHRSSTY-BOX <br /> CO&FLE rKDN COMPL-EnON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line — grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - 1Y. <br /> ft. <br /> — o <br /> SAMPLING slottedsocton 'c <br /> — 2 <br /> Holding Temperature <br /> vay'w pacx <br /> Method <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 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 />