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MONITORING WELL IN REPORT. <br /> Date: <br /> d I CONSTRUCTION <br /> Premise Address:16bb� v.. Jcc Total Depth <br /> Well No.:At A) I– I Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Inspector: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> T casing <br /> Consultani�i° <br /> T height <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CHA1M-BOX <br /> SPECIAL PERMIT INFO COMPLETION <br /> Ground Suiaca <br /> Distance to sewer line I.A, grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - _1 h. <br /> — m <br /> R <br /> m <br /> SAMPLING = o <br /> Flo tted — c <br /> Holding TemperaturegoL soc on <br /> Method I/del = pnvelpadc <br /> Screening Method <br /> Tracking Sheet - ( n ) _ <br /> n. = 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 /> Depth to water Buckets bentonite <br /> 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 /> EH 29 29 Type of method <br />