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,JNITORING WELL INSTALLATION REPG,W4,0 <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> t Screen Length (from) (to)—Oat <br /> Well No.: "V Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout *0 (to) <br /> Drilling rig I� <br /> Auger 0, ._21 <br /> I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller. height <br /> Consultant <br /> Geologist A80VE4RG1JND CHR*IY-SOX <br /> QOMPLEr;ON COof Ef1CN <br /> SPECIAL PERMIT INFO. Ground Sudwe <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ <br /> if yes, location and distant - <br /> SAMPLINGS " r abrai <br /> Holding Temperatures Pack <br /> Method '' <br /> Screening Method -V <br /> Tracking Sheet - (y/ n) <br /> fL <br /> n <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n PV <br /> Storage Location Casing type <br /> Blank„ g __ft Screen Pf ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 1 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size hl C 3 <br /> Installation Method Surge Block: - ( y pogist: <br /> Quantity Installed Discussed with geo <br /> - } / n ) <br /> Type of method <br /> EH 29 29 <br />