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LIONITORING WELL INSTALLATION REP <br /> Date: l - / S CONSTRUCTION <br /> L, ► <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: Ale— . <br /> Driller: casing <br /> height <br /> Consultant T7 TC <br /> Geologist •- T <br /> ABOVE-GROUND <br /> OONF ETION cHMM43Ox <br /> COMPl E=N <br /> SPECIAL PERMIT INFO. C3=nd Surface <br /> Distance to sewer line <br /> f grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - • <br /> SAMPLING :lotted <br /> sec�on <br /> Holding Temperature <br /> gmvW <br /> Method _ P <br /> a: <br /> ark <br /> Screening Method " — <br /> Tracking Sheet - (y/n ) <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 Bas sand/gravel <br /> P g 8r <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 />