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MONITORING WELL INSTALLATION REPvei`I' <br /> Date: t ` 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 /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> 7/4 <br /> Fr- <br /> Geologist <br /> J1BOVE48CUND CHAlM43OX <br /> DOWLETION COMPLEnON <br /> SPECIAL PERMIT INFO. Ormond$Wfacs <br /> Distance to sewer line <br /> great <br /> Domestic well on site - (y/ n <br /> If yes, location and distance - �. <br /> 0 <br /> SAMPLING <br /> iaC9cn r <br /> Holding Temperature %~ <br /> Method ' �. �ar� <br /> �a <br /> Screening Method : <br /> Tracking Sheet - (y/ n ) ` —' <br /> _ . <br /> ft. ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> i Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ ft ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />