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MONITORING WELL INSTALLATION REPORT <br /> CONS ON <br /> Date: <br /> Total Depth <br /> Premise Address: Screen Length (from) (Co)_ <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Grout (from) (to) <br /> inspector. Drilling rig type <br /> Auger O.D. _ I.D. <br /> Permit No. Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> �� casing <br /> Driller:' height <br /> '9 <br /> Consultant + <br /> Geologist A?l;VE-GRCUNO ChR STY30X <br /> COMPLETION COMPLETION <br /> -- <br /> Ground Sutxt <br /> SPECIAL PERMIT INFO. <br /> prat <br /> Distance to sewer line _ <br /> Domestic well on site - (y/ n) tt. <br /> if yes, location and distance - ft <br /> M <br /> C <br /> SAMPLING iloroi <br /> socicn — <br /> Holding Temperature travd'a�c <br /> Method so = <br /> _ <br /> Screening Method — <br /> Tracking Sheet - (y/n) ' — <br /> _ <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/n) Casing typ <br /> Storage Location Blank ft Screen —f <br /> Slot size <br /> Bags cement <br /> GROL1TlNG Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/11 ) <br /> Installation Method Discussed vrith geologist: - (y/ n) <br /> Quantity installed Type of method <br /> EH 29 29 <br />