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ONITORING WELL INSTALLATION REPO, <br /> Date: �� �� � CONSTRUCTION <br /> Premise Address: i �> W N Total Depth <br /> 7 r, i Screen Length (from) (to) <br /> Well No.: �' Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: v 2� Grout (from,) (to) <br /> Drilling rig type `_� Y✓��t , yoDSK G <br /> Permit No. D C Auger O.D. I.D. <br /> Completion - Stove pipe/chtistie box (circle one) <br /> Drilling Company <br /> Driller: 1e">_ casing <br /> I 7MT height <br /> Consultantn - —�^ <br /> T <br /> Geologisty r�% ✓ •4_ <br /> ABOVE-GRCUND CHRalY-SOX <br /> V CCMPLETICN CCMPLEnCN <br /> SPECIAL PERMIT INFO. G=nd Surt'a <br /> Distance to sewer line Oran <br /> Domestic well on site - (y/ T ft. <br /> If yes, location and distance - n, <br /> n. <br /> p <br /> O <br /> SAMPLING donad <br /> taCiCn = <br /> Holding Tepperature�-- = pavai pact <br /> Method ^ (")> Cfi z• , ;a <br /> Screenin Method <br /> Tracking Sheet - ( n) / <br /> ft. <br /> SPOILS <br /> Storage Method 7t MATERIALS/DEVELOPMENT <br /> Contamination Noted - y y n ) <br /> Storage Location 6 ) o K,n �� �� ��0t� �` � 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 />