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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: <br /> Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filtet Pack (from) (to) <br /> Inspector: Bentonite' (from) (to) <br /> Grout (from) (to) <br /> Permit No. Ding rig type ' <br /> Auger O.D. I.D. <br /> Drilling Company. Completion- Stove pipe/chnstie box (circle one <br /> Driller: <br /> casing <br /> Consultant ja- T— A <br /> height <br /> Geologist - <br /> ABOVE-GROUND <br /> ccwLETION CHRZ Y4= <br /> SPECIAL PERMIT INFO. COMPLEn.ON <br /> Ciruund Surixw <br /> Distance to sewer line <br /> Domestic well on site - <br /> (Y/n) <br /> If yes, location and distance - tt <br /> SAMPLING " __ c <br /> o <br /> Holding Temperature '°GAO" r = 2 <br /> Method ' _ VIvel Pack <br /> Screening Method _ .•' <br /> Tracking Sheet - (y/n) <br /> V <br /> SPOILS <br /> Storage Method <br /> Contamination Noted - (y/ MATERL9IS/DEVELOPMENT <br /> n) - <br /> Storage Location <br /> Casing type <br /> Blank ft. Screen ft- <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> - ---j- <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />