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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 /> Bento Pack (from)��(to) <br /> Inspector: Bentonite' (from) (to) <br /> Grout (from) Cto) <br /> Permit No. Dulling rig type <br /> Auger O.D._ I.D._ <br /> Drilling Company: Completion- Stove pipe/chnstle box (circle one <br /> Driller: <br /> casing <br /> Consultant � � height <br /> Geologist <br /> ABOVE-GROUND <br /> SPECIAL PERMIT INFO. COMPLETION CHRY-BOX <br /> COMPLETION <br /> Ground Surfxe <br /> Distance to sewer line <br /> Domestic well on site - (y/n) Qrout <br /> ! If yes, location and distance - <br /> f$ <br /> SAMPLING <br /> alottad <br /> Holding Temperature sx.tfon <br /> Method <br /> Screenin J, <br /> g Method " _ "vw Pack <br /> Tracking Sheet - (y/n) — <br /> ss, <br /> SPOILS <br /> Storage Method <br /> Contamination Noted -—(Y/n) MATERIALS�EVELOPMENT <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 Meth_o_d Filter Pack typesize <br /> Quantity Installed <br /> Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />