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MONITORING WELL INSTALLATION REPOR• <br /> Date: CONSTRUC17TON <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from)—(to)— <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: ��� casing <br /> height <br /> Consultant T <br /> T <br /> Geologist ABOVE.GRCUND <br /> COWLETION C>COMPL`MP -BOX <br /> L–=T1CN <br /> SPECIAL PERMIT INFO. Ground SuAx� <br /> Ort <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) . tt. <br /> If yes, location and distance - ft. <br /> R. <br /> ai = <br /> - o <br /> o <br /> SAMPLING alorai = a <br /> aoc9cn — <br /> Holding Temperature = pavd pads <br /> Method <br /> -ap = <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 />