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MONITORING WELL INSTALLATION 1 OORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from)—(to)- <br /> Bentonite <br /> from) (to)Bentonite (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/cliristie box (circle one) <br /> Driller: 1711 <br /> casing <br /> CosConsultant he±qht <br /> Geologist T <br /> ABCVE•GRCUND <br /> COMPLETION CHMM-80x <br /> SPECIAL PERMIT INFO. CCMPLEnCN <br /> C3round Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance <br /> • ft ft. <br /> V' 0 <br /> M <br /> SAMPLING o <br /> doroi — 'c <br /> socicn <br /> Holding Temperature = <br /> Method = gravel pact <br /> Screening Method <br /> Tracking Sheet - (y/ n ) " — <br /> '. <br /> ft. = fL <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 /> EH 29 29 Type of method <br />