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.ONITORING WELL INSTALLATION REPC <br /> Date:�,� �D CONSTRUCTION ' ye r <br /> Premise Address: ���` Tf Total Depth fo 0 <br /> Screen Length (from) � 0 (to) <br /> Wel] No. : Lt/ t Filter Pack (from) (to) <br /> Bentonite (from, (to) <br /> Inspector: Grout (from)_ 9(9 (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: casing <br /> height % \ <br /> i Consultant A66 ( � I <br /> Geologist ... <br /> ABOVEoGROUND <br /> COMPLETION CHAIM-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line "Out <br /> Domestic well on site - ( y / n ) 4 ft <br /> If yes, location and distance - ft <br /> 0 <br /> - C <br /> SAMPLING = <br /> slotted — 8 <br /> ' p vection ,a — <br /> Holding mperatu t U wF <br /> Method 2a4.1 ` _ gravel pacK <br /> Screening Method J (l — <br /> Tracking Sheet - / n ) /' _ <br /> ft. _ ft. <br /> SPOILS <br /> Storage Method ��Q MATERIALS/DEVELOPMENT <br /> Contamination Noted - � <br /> n ) <br /> Storage <br /> 1 u � V <br /> Storage Location Casing type p L <br /> Blank � ft. Screen to ft. <br /> Slot size Ok O LO <br /> GROUTING Bags cement_ f (� 4 '7 <br /> � a Buckets bentonite .fib <br /> Depth to water Z5 Bags sand/gravel <br /> Mix Ratios Filter Pack typesize Z v <br /> Installation MethodSurge Block: - ( y / <br /> Quantity Installed Discussed with geologist: - 6/ n ) <br /> Type of method <br /> EH 29 29 <br />