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MONITORING WELL INSTALLATION REPO.. , <br /> Date: / � CONSTRUCTION <br /> Premise Address: gbo� v~ � a � `� Total Depth <br /> Screen Length (from) (to) <br /> Well No. : 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 /> << height <br /> Consultant, <br /> � �QWIF <br /> GeologistA� 17 <br /> ABOVE-GROUND CHRI5fY BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Grourd SuAxw <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - <br /> n n. <br /> m <br /> o <br /> SAMPLING slotted <br /> (� section :< <br /> Holding Temperaturegravel pack <br /> Method &r,nu ` <br /> Screening Method <br /> Tracking Sheet - ny / 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 water Bagssand/ <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 />