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MONITORING WELL INSTALLATION REPT BT <br /> ��� <br />!� late: / CONSTRUCTION <br /> Premise Address: 4 ��� �'�L Total Depth <br /> Screen Length (from) (to) <br /> Well No. : Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: f� K ^�R Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant �< < dy <br /> 3 <br /> 1 Geologist <br /> ABOVE-GROUND <br />? COMPLETION CHRZ7 BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. ground Surfaeo <br /> 6 <br /> 1 Distance to sewer line grout <br />.' Domestic well on site ( y / n ) <br /> If yes, location and distance - n' <br /> n. <br /> n. <br /> SAMPLING = <br /> slonad c <br /> Holding Temperature _ P <br /> aCR <br /> Method = <br /> Screening Method g <br /> Tracking Sheet - ( y / n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type <br /> Blank h. 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 />