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rviONITORING WELL INSTALLATION REPO-,W <br /> Date: T CONSTRUCTION <br /> Premise Address: �{ b3 Total Depth a <br /> Screen Length (from) CEO) <br /> Well No.: � � �� Filter Pack (from) (to)Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type 41 <br /> Permit No. <br /> Z Auger O.D. LD <br /> Completion - Stove pipe/ stie o�)(circle one) <br /> Drilling Company: <br /> height <br /> Driller. casing <br /> � <br /> Consultant m <br /> —EWTE <br /> Geologist ^ �^���^ ABOVE-GRCUNO <br /> COAFLETION C-OWPLEMN <br /> CCMPI.ETICN <br /> SPECIAL PERT INFO. ��Gro+�Sudan <br /> MI <br /> prart <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - p, tt. <br /> O <br /> SAMPLING Blotter! = c <br /> tacicn <br /> Holding Temperature pads <br /> Method_, : <br /> Screening Method UV _ <br /> Tracking Sheet • (y/ n) <br /> tt. <br /> SPOILS <br /> Storage Method S� C < e MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / n ) fn C ) (p I 0-E-jk5�� v <br /> Storage Location a � L A Casing type 1 <br /> LN Blank ft. Screen 2c7 .ft- <br /> ry� <br /> /lA 8 Slot size <br /> GROLMNG Bags cement <br /> f Buckets bentonite <br /> Depth to watBags sand/gravel <br /> Mix Ratios Filter Pack type/size r'nC 3 Ir Y <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />