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MONITORING WELL INSTALLATION REP,rtT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Benronice (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 /> casing <br /> Driller heighr <br /> ♦ 7 r <br /> Consultan[ <br /> Geologist <br /> ABCVEvRCUND CFGZTY30X <br /> CCNFLr4N COMPL -iicN <br /> SPECIAL PERMIT INFO. G=nd <br /> Distance to sewer line I <br /> Domestic well on site - ( y/ n ) i if yes, location and distance - tL <br /> s <br /> 0 <br /> SAMPLING sloead = <br /> wccn FE <br /> Holding Temperature _ _ 72YO,Pack <br /> Method <br /> Screening Method . <br /> Tracking Sheet - ( y/ n ) j. <br /> OL T = T tL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft Steen fr- <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gtavel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block. - (y/ n ) <br /> Quantity installed Discussed with geologist - C y/ n) <br /> Type of merhod <br /> EH 29 29 <br />