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MONITORING WELL INSTALLATION REPP"T <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filter Pack (from)—(to)— <br /> Inspector: <br /> from) (to)Inspector: Bentonite (from)—(to)— <br /> Grout <br /> from) (to)Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> T casing <br /> ConsultantT height <br /> Geologist _ + T <br /> ABOVEGROUND <br /> 00164121-ErCN CHRtSTY-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Satan <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> tt tt. <br /> SAMPLING abtfad c <br /> Holding Temperature soon <br /> Method — Ra`w Pack <br /> Screening Method <br /> a <br /> Tracking Sheet - (y/ n ) — <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 /> Buckets bentonite <br /> Depth to water—La-0- -t Bags sand/gravel <br /> Mix Ratios c a--ta--t 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 />