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1 <br /> casing <br />Irt height <br />, , \er <br />A.80%1E-GRO4JND <br />ODVPLETION 01-iStSTY-80X <br />COMPLETION <br />afONITORING WELL INSTALLATION REP <br />Date: /OMAN <br />Premise Address: trU <br />Well No.: A4 k) Le <br />Inspector: <br />Permit No. <br />Drilling Company: A-10-- <br />Driller: <br />Consultant Ir'cç L "11,42/1_ <br />Geologist <br />Distance to sewer line <br />Domestic well on site - ( y / n) <br />If yes, location and distance. <br />CONSTRUCTION <br />Total Depth <br />Screen Length (from) (to) <br />Filter Pack (from) (to) <br />Bentonite (from) (to) <br />Grout (from) (to) <br />Drilling rig type <br />Auger O.D. I.D. <br />Completion - Stove pipe/christie box (circle one) <br />ft. <br />SPECIAL PERMIT INFO Ground Surfacs <br />grait <br />ft. <br />ft. bentontle sea/ /Ai 71 <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SAMPLING <br />7avg4 pack <br /> ft. <br />SPOILS <br />Storage Method <br />Contamination Noted- ( y / n) <br />Storage Location <br />MATERIALS/DEVELOPMENT <br />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 Filter Pack type/size <br />Installation Method <br />Quantity Installed <br />Surge Block: - ( y / n) <br />Discussed with geologist: - ( y / n ) <br />Type of method <br />EH 29 29