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MONITORING WELL INSTALLATION RET"RT <br /> Date'. d CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: I� J4�j f� Filter Pack (from) (to) <br /> 3entorliInspector: (.CTC�"'M�` ` Grout tQ (from) (to) <br /> 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 /> Geoleglst ( S <br /> = AB6VE-GF IOUND <br /> OOAAPLErCN CHR*7Y-BOX <br /> COMPLEnON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> ft. <br /> tt. <br /> M' C <br /> SAMPLING = o <br /> alottad w, — � <br /> &action — <br /> Holding Temperature <br /> Method _ g"w pack <br /> — <br /> Screening Method _ <br /> Tracking Sheet - (y/n) <br /> :x <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 /> r� Buckets bentonite <br /> Depth to water_ _ r 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 /> r <br />