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MONITORING WELL INSTALLATION REP-e-T <br /> Date: f/- fi (72 CONSTRUCTION <br /> premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> [nspector: � � 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. <br /> Driller cas Lng <br /> r77height <br /> Consultant <br /> Geologist <br /> ABOVE-GRCUND CHRZ,41-8aX <br /> SPECIAL PERMIT INFO. 0-aind Sul'°' <br /> ?rout <br /> Distance to sewer line 1 <br /> Domestic well on site - ( y/ n } �. <br /> If yes, location and distance - ft <br /> O <br /> SAMPLING :bid y <br /> • �� 3 <br /> i1C.Cri -_ <br /> Holding Temperature . <br /> ti• w' <br /> Method FF = <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> 'L — Y tL C <br /> SPOILS , <br /> V <br /> c/' <br /> Storage Method MATERIAL,S/DEVELOPMENT r' <br /> Contamination Noted - (y/ n ) Casin �l <br /> Storage Location Blank Pe <br /> Blank ft. Steen —h- <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravei <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - C y/ n ) <br /> Quantity Installed Discussed with geologist: - C y <br /> Type of method <br /> EH 29 29 <br />