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MONITORING WELL INSTALLATION REPUKT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No. : CFT Filter Pack (from) (to) <br /> ��� p Bentonite (from) (to) <br /> Inspector: LtyA Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. [.D. <br /> Completion . Stove pipe/christie box (circle one) <br /> Drilling Company: 6A,lJvU . <br /> Driller: casing <br /> height <br /> Consultants <br /> Geologist <br /> ABOVE-GACUND Ct6iISTY80X <br /> COMPI ETION COMPLETION <br /> SPECIAL PERMIT INFO. �o Ground Surtact <br /> Distance to sewer line grout <br /> Domestic well on site - ( yn ) <br /> If yes, location and distance - ft. <br /> *Fool <br /> FFF <br /> V. Flo <br /> SAMPLING dot'.ud <br /> F; cn —_ <br /> Holding Temperature pop = govd Pack <br /> Method FFFF .1 <br /> Screening Method low F. <br />! Tracking Sheet - ( y / n ) <br /> It° <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 /> O GI Buckets bentonite <br /> Depth to water 0 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 />