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AONITORING WELL 1NSTALI AT1ON REP - <br /> Date: <br /> CONSTRUCTION <br /> _ 1 1 <br /> -r� •�? <br /> Premise Address: Total Depth Screen Length (from)„ (to) <br /> l L���Z Filter Pack (from) (to}---- <br /> Well No.: Bentonite (from) (to). <br /> Inspector: (to) � <br /> Grout (from) <br /> Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: - <br /> casing <br /> Driller: C height <br /> Consultant C - — <br /> Geologist �- J480VE-GROUND ' <br /> COMPLETION cOMPLETION <br /> t;OMPLr�TION <br /> SPECIAL PERMIT INFO. Ground S <br /> Grout <br /> Distance to sewer line <br /> Domestic well on site - (y J n) ft. <br /> If yes, location and distance - it. <br /> ft. <br /> IP <br /> o _ <br /> y A <br /> SAMPLING slottad Y — C <br /> soeon _ <br /> Holding Temperature `' �" Gravel pack <br /> Method <br /> Screening Method .-= <br /> Tracking Sheet - (y/n } ; <br /> .a- <br /> � , ft, w 1 . <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 benttte <br /> Depth to water Bags sand/gr <br /> Mix Ratios Filter Pack tyInstallation ethod Surge Block:Quantity Installed Discussed wi - ( y/ nType of meth <br /> EH 29 29 <br />