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MONITORING WELL INSTALLATION REP/9 <br /> Date: I b 0 CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: f Grout (from)—(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. LD. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: <br /> height <br /> Consultant 7— —qw, <br /> Geologist-7-p-". <br /> a" ABovE GROUND <br /> 001.FLET10N COMPLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. ���Ground Surface + <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n) ft. <br /> If yes, location and distance - ft. <br /> _ o <br /> o <br /> 'c <br /> SAMPLING �tacion <br /> t`6L <br /> Holding Temperature ( _ Va"af Pack <br /> Method <br /> Screening Method —_ <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blame fr. Screen ft• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> / Bags sand/gravel <br /> Depth to <br /> Ratios water 4 -�/ > Filter Pack type/size <br /> Mix RatiSurge Block: - (y/ n ) <br /> Installation Method Discussed with geologist: - ( y/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />