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MONITORING WELL INSTALLP.'IION P -T <br /> CONSTRUCTION <br /> Date: <br /> Total Dcpth (to) <br /> Premise Address: Screen Length (from) <br /> Filter Pack (crom) (to) <br /> well No.: — Bentonite (arom) (CO) <br /> Grout (from) (to) <br /> Inspector•. Drilling rig t Pe <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/chrisne box (cL, one) <br /> Drilling Company <br /> casing <br /> Driller: � heicht <br /> Consultant — w' <br /> Geologist l��-.-GBC,UND <br /> Cx�:rrJ S�z'.a-t <br /> SPECIAL,pERh4T INFO, Qra t <br /> Distance to ,ewer line <br /> Domestic well on site - ( y <br /> if yes, location and distance <br />� _ r <br /> C <br /> 1 0 r-.-d <br /> SAMPLING socicn - _ <br /> Holding Temperature -- - <br /> Method " — <br /> Screenino Method ' <br /> Tracking Shcet - (y/ n) -- _ <br /> � <br /> SPOILS <br /> M_ ATERIA�/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - C y/ n) Casing type <br /> Storage Location Blank fc Screen <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/grovel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - ( Y/ 11 ) <br /> installation Method Discussed with geologist: - (y/ n ) <br /> Quantity Installed Type of rnctliod <br /> EH 29 29 <br />