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MONITORING WELL INSTALLATION REPORT <br /> Date: 10. 1t <br /> h7 CONSTRUCTION <br /> Premise Address: Total Depth 0 / <br /> Screen Length (from) (to) <br /> Well No.: i ' / /��' Filter Pack (from) (to) <br /> Bentonite (from)-(to)— <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> vA Completion - Stove pipe/christie box (circle one) <br /> U <br /> Driller: <br /> casing <br /> L <br /> Consultant � � L height <br /> Geologist _ T <br /> ABOVE-GROUND <br /> CONFLE ICN CHRIM43OX <br /> SPECIAL PERMIT INFO. Ground guriyy COMPLETION <br /> Distance to sewer line Ott <br /> Domestic well on site - (y/ n) tt <br /> If yes, location and distance - <br /> tt tt. <br /> P <br /> SAMPLING <br /> 0 <br /> slotted — E <br /> Holding Temperature <br /> Method �' P <br /> Screening Method " — <br /> Tracking Sheet - (y/ n ) ¢ <br /> —ft. <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 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 />