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- MONITORING WELL INSTALLATION REPOh f <br /> Date: // 7 CONSTRUCTION <br /> Premise Address: /)tea Wil,JA- �– Total Depth <br /> Screen Length (from) (to) <br /> Well No.: �� I w Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: 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: casing <br /> Theight <br /> —ta <br /> Consultant "b <br /> Geologist LLtQ 7//,lW7F <br /> ABOVE-GROUND CHRM Y-8oX <br /> COWPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. around Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - <br /> ft. f1. <br /> e <br /> o <br /> SAMPLING slottad <br /> &*don <br /> y�i✓ <br /> Holding Temperature = gr&„91 pack <br /> Method <br /> Screening Method ` <br /> Tracking Sheet - /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 wateBags 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 />