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IONITORING WELL INSTALLATION REI ° <br /> Date: U ✓ CONSTRUCTION <br /> Premise Address: % Total Depth <br /> // Screen Length (from) (to) <br /> Well No.: — w" (D Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> Completion - Stove pipe/ uistie b (circle one) <br /> Drilling Company: <br /> Driller: � T casing <br /> T height <br /> Consultant IV —CWT <br /> 7//, <br /> Geologist <br /> ABOVE-GRCUNO CHRZTY-30X <br /> CCMPLETCN CCMPL.rcTICN <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) �_.ft. <br /> If yes, location and distance - ft- <br /> ft. <br /> -a <br /> SAMPLING ,ioro.i <br /> soc'cn <br /> Holding Temperature = g,,,91 Pack <br /> Method <br /> Screening Method : — <br /> ':r.: <br /> Tracking Sheet - ( y/ 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 Bags 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 />