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CONS YRUCTION <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 />ABOVE-GRCUND <br />CCIVPLETiON <br />-ft <br />casing <br />height <br />CNAISTY-BOX • <br />COMPt.ETION <br />Ocoutxt St:fact <br />grcut <br />ft. <br />ft. <br />slortshi <br />secicn <br />griv91 pack <br />MONITORING WELL INSTALLATION REPO.‘e <br />Date: <br />Premise Address: r)O ek1.1 ILA . <br />Well No.: <br />Inspector: \W <br />Permit No. <br />Drilling Company: <br />Driller: <br />Consultant (-)C <br />Geologist (3AA:1 <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature P <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPOILS <br />Storage Method <br />Contamination Noted. ( y / n) <br />Storage Location <br />GROUTING <br />Depth to water <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />MATERIALS/DEVELOPMENT <br />Casing type <br />Blank ft. Screen ft. <br />Slot size <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - ( y / n) <br />Discussed with geologist: - ( y / n ) <br />Type of method <br />EH 29 29