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MONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to} <br /> Well No.: Filter Pack (from),_ <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to)� <br /> Drilling rig type <br /> Auger O.D. I.D. <br /> permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: � IT Height <br /> Consultant •Z- <br /> Geologist Aj;vE4FRCUNfl <br /> COMPLETION Ct�F1iSTY-e0X <br /> ccmPLE ON <br /> SPECIAL PERMIT INFO. <br /> Grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) <br /> If.yes, location and distance - n• <br /> SAMPLING sbrai �: <br /> soc�cn <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> k <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n} <br /> Storage Location Casing type <br /> i-ABlank ft. Screen ft. <br /> Slot size <br /> 3; <br /> GROUTING .. Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/graveI <br /> i <br /> Mix Ratios Filter Pack type/size <br /> Installation Method_ Surge Block: - (y/n ] <br /> Discussed with geologist: - (y/ n <br /> Quantity Installed ) <br /> Type of method <br /> EH 29 29 <br />