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MONITORING WELL INSTALLATION REP,--P <br /> CONSTRUCCION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Benronite (from) (to) <br /> Inspector. 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. cas Lag <br /> hetghc <br /> Consultant ♦� <br /> Geologist _ <br /> ASCVEv^RCUND U' Ti <br /> CrbP�=TION G1RI57`!-30X <br /> CG)MPtcTiCN <br /> SPECIAL PERMIT [NFO. Ground SLrfac* <br /> Distance to sewer line dart <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - �- <br /> I _ <br /> 3 <br /> i.. a <br /> SAMPLING - <br /> Ila <br /> `a <br /> wcrcn <br /> Holding Temperature n <br /> :Method <br /> Screening Method — <br /> Tracking Sheet - ( y/ n ) :j< <br /> :t. r = ♦ n <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Conramination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank fL Screen f <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravei <br /> Mix Rarios Fater Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ a) <br /> Type of method <br /> EH 29 29 <br />