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`MONITORING WELL INSTALLATION RUMT <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 /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant IV V <br /> Geologist T <br /> ABOVE-GBCUNO <br /> CCkFL CN c4msi _acx <br /> CaI L_'77'1CN <br /> SPECIAL PERMIT INFO. g { <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> li yes, location and distance - ft. <br /> K. <br /> SAMPLING '. <br /> 0 <br /> sicra j <br /> :aCicn <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> T racking Sheet - (y/ n } " <br /> . = fL <br /> SPOILS <br /> Storage Method MATERIALSMEVFLOPMENT <br /> Contamination Noted - (y/ n ) T <br /> Storage Location Casing type <br /> Blank ft. Screen fr. <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 mediod <br /> EH 29 29 <br />