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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> 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/christie box (circle one) <br /> Driller: casing <br /> Consultant height <br /> Geologist vv—f <br /> ABOVE-GROUND <br /> COMPLETION C4Rlm-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surface <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - tt, <br /> tt. tt. <br /> m <br /> SAMPLING = o <br /> slotted <br /> = S <br /> Holding Temperature secdon <br /> — <br /> Method = pave pack <br /> Screening Method — <br /> Tracking Sheet - (y/n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen g, <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth twater Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br /> i <br /> 0 <br />