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4MONITORING WELL INSTALLATION REOIT <br /> CONSTRUCTION <br /> IVl 101, <br /> v _ Total Depth <br /> Screen Length (from) 1 OL- (to) <br /> Filter Pack (from)-(to)— <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Auger O.D. LD. <br /> Completion - Stove pipe/christie box (circle one) <br /> casing <br /> height <br /> Consultant <br /> —WW–f <br /> Geologist ABOVE-GROUND CHRZTY4= <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surt'a <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> if yes, location and distance - ft. <br /> = r <br /> O <br /> SAMPLING dotted _ ^c <br /> wc5on S <br /> Holding Temperature _ gmvW pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) aK. <br /> SPOILS 1°a <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Lt° <br /> Storage Location Casing type 5) <br /> Blank ft. Screen 1 S ft. <br /> Slot size S S 02 O <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 2 <br /> Mix Ratios Filter Pack type/ 'ze q i 10 i <br /> Installation Method Surge Block: - (Y/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />