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MONITORING WELL INSTALLATION REPOR•TT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from)—([O)- <br /> Inspector: <br /> from) (to)Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/duistie box (circle one) <br /> Drilling Company: <br /> Driller: � casing <br /> height <br /> Consultant <br /> Geologist �-Gap <br /> COWLETfON C-0MP Y•80x <br /> CCh4Pt -cTICN <br /> SPECIAL PERMIT INFO. +� + <br /> gran <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n) ft. <br /> If yes, locadon and distance - ft. <br /> tt. <br /> = m <br /> M <br /> C <br /> O <br /> SAMPLING rlorad <br /> tocicn —_ <br /> Holding Temperature <br /> Method <br /> • Screening Method <br /> Tracking Sheet - (y/ n ) <br /> —ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type —fr <br /> Blank ft. Screen <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 /> -4tst0adon Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 2929 <br />