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•MONITORING WELL INSTALLATION REPPRT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filter Pack (from)—(to)- <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/duistie box (circle one) <br /> Driller: casing <br /> Consultant height� '4 <br /> —W <br /> Geologist V <br /> ABOVE-GACUND <br /> COMPLETION CH815TY-BOX <br /> SPECIAL PERMIT INFO. Groin SurfaceCOMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft, <br /> • ft ft. <br /> - _ m <br /> SAMPLING = s <br /> slorad = �c <br /> •oricn = <br /> Holding Temperature = <br /> Method = ynvalpack <br /> a = _ <br /> Screening Method <br /> Tracking Sheet • (y/ n ) M <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/ 11 ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />