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IONITORING WELL INS'T'ALLATION REP( <br /> V <br /> Date: /obil'07 CONSTRUCTION <br /> Premise Address: I� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: G 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 /> Geologist i�trnn.w •" <br /> ABOVE-GROUND CNAIS7N-BOX <br /> CO MP LETCN COMPLETION <br /> SPECIAL PERMIT INFO. Gmund Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ nn. <br /> If yes, location and distance - <br /> ft. <br /> m <br /> q <br /> ID <br /> Q, O <br /> SAMPLING W�r " atatted <br /> (fjD aacson ' <br /> Holding Temperature 7 (/ _ _.— y. graver PaCR <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> K, <br /> SPOILS <br /> Storage Method MATERIALS EVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROLMNG 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 />