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MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: - <br /> Total Depth (to) <br /> Premise Address: Screen Length (from)__— <br /> Filter Pack (from)�(to) <br /> Well No.: Bentonite (from) Cto) <br /> Grout (from)_---(to) <br /> Inspector. Drilling rig type <br /> Auger O.D.-- I.D. -- <br /> Permit No. Completion - Stove pipe/clutstie Tox (circle one) <br /> Drilling <br /> Company—casing <br /> Duller: he igh[ <br /> Consultant <br /> Geologist A!;;7 -GfiCUND cl+GZilf-Box <br /> CO W LEDON COMPLETION <br /> �...Ground Staiacn <br /> SPECIAL PERMIT INFO. yrat <br /> Distance to sewer line It• <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft. <br /> — o <br /> = o <br /> �lorai <br /> SAMPLING 3, cn <br /> Sravd Pads <br /> Holding Temperature <br /> Method — <br /> Screen'ngMethod = •. <br /> Tracking Sheet - (y/ n) tt• __ — ft. <br /> SPOILS <br /> to ATERI ALS/DEV ELOPMENT <br /> Storage Method <br /> Contamination Noted- (Y/ n) Casing type <br /> Storage Location Blank — <br /> ft Screen��fr' <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water, �� I' E S Filter Pack type/size <br /> Mix Ratios Surge Block: - (Y/n ) <br /> ,Jpstallation Method Discussed with geologist: - (Y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />