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MONITORING WELL INSTALLATION REPT <br /> Date:_ c�/�fi <br /> T—� CONSTRUCTION <br /> Premise Address: & <br /> Total Depth 04 <br /> aiw )Well No.: 60)%k Screen Length (from (to <br /> ) <br /> Filter Pack (from) (to) <br /> Inspector: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D, I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie�box <br /> Driller: <br /> TT casing <br /> T <br /> Consultant height <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CNRISTY-BOX <br /> SPECIAL PERMIT INFO COMPLETION <br /> Circund Sauce <br /> Distance to sewer line orae <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - 1 n, <br /> n n. <br /> = m <br /> = m <br /> SAMPLING = o <br /> slotted — 2 <br /> Holding Te �eran" yBL s°r'°n = <br /> Method s� gravel pads <br /> Screening Meth _— <br /> Tracking Sheet - (y/ n) " — <br /> n. = n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ ) <br /> Storage Location Casing type <br /> Blank h. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> i <br /> Depth to wateBuckets bentonite <br /> r�'� <br /> Mix Ratios Bagssand/gravel <br /> Filter Pack type/size <br /> Installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />