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' MONITORING WELL INST TION REPOT, <br /> Date:– CONSTRUCTION <br /> Premise Address; Total Depth <br /> Screen Length,(from) (to) <br /> Well NO,: Pack (from) An (to <br /> J Bentonite (from) (to) <br /> Inspector: , VI Grout: (from) (to)–� <br /> Drilling rig type <br /> Permit No, Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> s � � <br /> height <br /> Consultant 7 WT <br /> Geologist <br /> ABOYE-GRCUND C4-FtM-80X <br /> CONFLETC N C 0MPLETION <br /> SPECIAL PERMIT INFO. Ground Surfaco <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) �� . ft. <br /> Ifyes, location and distance - <br /> fL <br /> tt. <br /> SAMPLING 110ned i <br /> sedcri <br /> Holding Temperature .w 9r%V11 t <br /> adt <br /> Method <br /> Screening Method — <br /> Tracking Sheet - C y/ n ) <br /> SPOILS . <br /> u <br /> Storage Method IMATERIA &DEVELOPMENT <br /> Contamination Noted - (y/ n) - <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> 4 Buckets bentonite <br /> Depth to waterI bo 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 />