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MONITORING WELL INSTAL t UON REPORT <br /> Date: <br /> CONS�ON <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. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: Completion-- Stove pipe/christie box <br /> (circle <br /> Driller: <br /> casing <br /> Consultant height <br /> Geologist <br /> 1 ABOVE-dROUND <br /> i SPECIAL PERMIT INFO. COWLETION CHR5N•BOX <br /> COMPLETION <br /> 'Ground Surface <br /> Distance to sewer line <br /> Domestic well on site - (y/n) Aran <br /> If yes, location and distance - <br /> . ft. <br /> _ o <br /> SAMPLING . ' <br /> _ slortad <br /> Holding Temperature aacdon A <br /> Methods <br /> Screening Method VW <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method <br /> Contamination Noted -—(Y/n) MATERIAIS/DEVELOPMENT <br /> Storage Location <br /> Casing type <br /> Blank fc. Screen fc. <br /> GROU 17N 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 /> Quantitylnstalled _..._. _. -----.-SI#rge Blosk:_(_Y-/-na <br /> Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />