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r i <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: Screen Length (from) (to) <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/clu-istie box (circle one) <br /> Driller: <br /> casing <br /> Consultant - ,�, height <br /> Geologist _ - <br /> ABOVE-GRCUND <br /> OONFLEMN C*-S SM-30X <br /> SPECIAL PERMIT INFO. COMPUEMON <br /> Cicound Suiaca <br /> Distance to sewer line orart <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> SAMPLING oc <br /> soden <br /> Holding Temperature <br /> Method —' Lraval pack <br /> Screenin;Method r __ <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank —f r- 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 /> EH 29 29 Type of method <br />