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�--MONITORING WELL INSTALLATION REP%,� <br /> Date: CONSTRUCTION <br /> Premise Address: 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 /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant4n <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CHRZTY43OX <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Sufacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - • <br /> ft. <br /> 1 _ <br /> IS <br /> • <br /> SAMPLING tlofted v <br /> "cdon —_ <br /> Holding Temperaturegmvo P <br /> ack <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n1-4) <br /> f. = tt. <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 />