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�NITORING WELL INSTALLATION REP <br /> Date: <br /> S/U/00 CONSTRUCTION <br /> / ' <br /> Premise Address: �7� tdtn Total Depth <br /> Qp Screen Length (from) (to) <br /> Well No.: /Ltr J �� I � � S "* t Filter Pack (from) (to) <br /> Bentonite (from)—(to)- <br /> Inspector: <br /> from) (to)Inspector: <br /> Grout (from)-(to )- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> Consultant��` — T <br /> Geologist AE0c E-GROUND CHRZ1-y45OX <br /> CON FLETION cOMPLETION <br /> SPECIAL PERMIT INFO. ��Ground$ + <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n) ft <br /> If yes, location and distance - ft• <br /> = a <br /> SAMPLING ��p sd <br /> saco .F <br /> Holding Temperature`I' - gfiWPack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) % = <br /> tL <br /> SPOILS <br /> Storage Method <br /> 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 /> .f r r 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 />