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t <br /> -MONITORING WELL INSTALLATION REPORT <br /> Date: _ CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Wel] No. Filter pack (front) oto) <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 /> Driller: <br /> -- �(—� casing <br /> i <br /> Consultant height <br /> Geologist _ _^ <br /> Il3OVE-G R OUN D —fmwT <br /> CO WF LET1C N C�{^z7y-BO x <br /> SPECIAL PERMIT INFO, COMiPLETON <br /> Ground Surixa <br /> Distance to sewer line _ grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - <br /> h. <br /> = m <br /> _ a <br /> = m <br /> SAMPLING — o <br /> dotted — c <br /> 21 <br /> Holding Temperature — <br /> Method = gra rel;acx <br /> Screening Method <br /> Tracking Sheet - ( y/n ) _ <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 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 />