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MONITORING WELL INSTALLATION REPORT <br /> t <br /> Date: / CONSTRUCTION <br /> Premise Address:--/� w� 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 /> MVT <br /> Geologist <br /> —q <br /> ABWE-GROUND CHR1M43OX <br /> COMPLEI.10N COMPL_wT1CN <br /> SPECIAL PERMIT INFO. Grournd Surface <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n) --- --- --'-ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING <br /> sacicn % — <br /> Holding Temperature _ <br /> Method '~ _ F <br /> ack <br /> Screening Method <br /> w' — <br /> Tracking Sheet - (y/ n <br /> _...........tt. ,_V...... = 1t. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank fr. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />