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.NITORING WELL.INSTALLAReN REP( <br /> Date:__ ITS ICONSTRUCTION <br /> Premise Address: . of v� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> 4 <br /> Drilling rig type <br /> Permit No. 4L/I Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: AWA <br /> Driller: At, casing <br /> height <br /> Consultant <br /> Geologist .. <br /> ABOVE-GROUND CNAISTY-box <br /> COM?LET10N COMPLEMCN <br /> SPECIAL PERMIT INFO. G=nd Sumac# <br /> Distance to sewer line af0"t <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> — m <br /> SAMPLING slorod <br /> = a <br /> socicn =_ <br /> Holding Temperature — <br /> Method — FaCK <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) r" _ <br /> tt. — i rft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/ n ) (I lc; � <br /> Storage Location Casing type cL <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 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 />