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MONITORING WELL INSTALLATION REPuKT <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. '.D. <br /> ­x- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist ._ <br /> ABOVE-GACUND <br /> COMPLETION CHRZTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. (mrd Surf act <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) ft- <br /> If yes, location and distance - ft- <br /> ff. <br /> - O <br /> w <br /> - C <br /> SAMPLING = <br /> soccicn <br /> Holding Temperature _ gavw F <br /> ack <br /> Method — <br /> Screening, Method = <br /> Tracking Sheet - ( y/ n ) r' — <br /> ft. <br /> fL <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 i Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of metliod <br /> EH 29 29 <br />