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J <br /> M_ONITORING WELL INSTALLATION REPORT <br /> Date: _ CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack <br /> _ (from, (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) –(to)— <br /> Drilling <br /> to)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 /> Consultant _ <br /> 1 height —9 <br /> Geologist _ <br /> ABOVE-GROUND <br /> COF,9LET10N CHRIS Y-aOX <br /> COMPLETON <br /> SPECIAL PERT INFO. Ground Surixa <br /> MI <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> __ — a <br /> = m <br /> C <br /> SAMPLING slotted <br /> Holding Temperature <br /> Method — Gni Pack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> ft. = IFft. <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 /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size <br /> installation Method _ Surge Block: - ( y/ n ) <br /> )uantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> 2929 <br />