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MONITORING WELL INSTALLATION RE� <br /> Date: 1 6 S CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> p fl Q Bentonite (from) (to) <br /> Inspector: hd b Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> /'� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: I ,N/Y <br /> Driller:— casing <br /> +* height <br /> —QVT <br /> Consultant <br /> Geologist C - <br /> ABOVE-GROUND CHAISTY-BOX <br /> COLFLlTION COMPLETION <br /> SPECIAL PERMIT INFO. Ground BuAati <br /> Distance to sewer line PER <br /> grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - <br /> ft ft. <br /> = m <br /> e <br /> O <br /> SAMPLING slanad <br /> section =_ <br /> Holding Temperature = P <br /> ack <br /> Method = <br /> Screening Method <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 (��� Bags sand/gravel <br /> Mix Ratios 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 />