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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filtet Pack (from) (to)___ <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) <br /> (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> . <br /> Driller: '� casing <br /> height <br /> Consultant <br /> Geologist <br /> A80VE-daOUND <br /> COMPLETION C4-SZTY-DOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> C3round Staiace <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance- <br /> = m <br /> — a <br /> _= m <br /> SAMPLING — o <br /> slotted — c <br /> :> <br /> sardon <br /> Holding Temperature <br /> Method — gmvsl path <br /> Screening Method <br /> Tracking Sheet - (y/n) I = <br /> SPOILS <br /> Storage Method MATERIALS/DEVEL6PMENT, <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth twater 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 /> EH 29 29 Type of method <br />