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*MONITORING WELL INSTALLATION REIT <br /> Date: _ CONST_RU CTfON <br /> Premise Address: _ Total Depth <br /> Screen Length (from)__(to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) - <br /> (to)-Inspector: Grout (Prorn) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company. _— <br /> Driller: casing <br /> height <br /> Consultant —QV' <br /> Geologist 171 <br /> ABOVE-GRCUNCiiAlSiY80X <br /> COMPLEffON COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surf -0 <br /> Distance to sewer line 9fOm <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - It, <br /> ft. <br /> SAMPLING dara9 <br /> axdon — <br /> Holding Temperature N = rravol F <br /> Method " = <br /> :k = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ft, <br /> SPOILS <br /> Storage Method MATE RIALS/DEVELOPIvIENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank �ft, Screen ft. <br /> Slot sire <br /> GROUPING Bags cement, _ <br /> Buckets bentonite _ <br /> Depth to Nvater_ __ flags sand/gravel__i_ <br /> Mix Rapos � FiRer Pack <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed—,— - �,i,— Discussed with geologist: - ( y/ n ) <br /> Type of <br /> EH 29 29 <br />