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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/chnstie box (circle one) <br /> Driller: casing <br /> Consultant height ' <br /> Geologist T <br /> ABOVE-GFOUND T <br /> C011PLETION CNAI.STY-80X <br /> SPECIAL PERMIT INFO. COMPLEnON <br /> C�cnund Surface <br /> Distance to sewer line grout <br /> Domestic well on site . (y/n) <br /> If yes, location and distance - 1 n <br /> n ft. <br /> A <br /> - 0 <br /> SAMPLING = o <br /> Flo tted — 'c <br /> wc9on _ <br /> Holding Temperature y > <br /> Method _ — praval pacsc <br /> Screening Method = <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Method MATERIAIS/DEVELOPMENT <br /> Contamination Noted - (y/n) - <br /> Storage Location Casing type <br /> Blank ft. Screen g, <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Filter Pack typesize <br /> Installation Method _ _.Surge Block:_(-y-/tet_)__ <br /> Quantity Installed <br /> Discussed with geologist: - (y/n ) <br /> EH 29 29 Type of method <br />