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C'AONITORING WELL INSTALLATION REPU <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 /> f Drilling rig type 3 <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 ���p-}/-�.�,��/�+�//�.�Q//��J����� <br /> i - r AE; f`GPSr7�'{CUN.`D �//r4�1M/P1�Ei 4= - <br /> nON <br /> SPECIAL PERMIT INFO. G=nd Surface <br /> Distance to sewer Iine <br /> Domestic well on site - (y/ n) �....r.._.. .ft. <br /> If yes, Iocation and distance - ft. <br /> n. <br /> e« ip: <br /> 'M1 C <br /> SAMPLING sbt•.a.i ;a GG <br /> f ri <br /> saCSon �- <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> �.^.�ft• ..�.... ft. <br /> SPOILS ¢ <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> ' BIank 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 />