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MONITORING WELL INSTALLATION REPT-RT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from)_(to)- <br /> Well <br /> from) (to)Well No.: Filter Pack (from)—(to)- <br /> Bentonite <br /> from) (to)Bentonite (from)—(to)- <br /> Inspector: <br /> from) (to)Inspector: Grout (from)—(to)- <br /> Drilling <br /> from) (to)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 <br /> Geologist — —QV <br /> ABOVE-GROUND CHRtSTY-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground S�aiacw T <br /> Distance to sewer line groin <br /> Domestic well on site - (y/ n) <br /> n. <br /> If yes, location and distance - <br /> n. <br /> n. _ <br /> C <br /> O <br /> SAMPLING dotted <br /> taction <br /> Holding Temperature = grayw Pack <br /> Method — <br /> Screening Method <br /> rY. <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location ming 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 />