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r <br /> MONITORING WELL INSTALLATION REPORT <br /> Dater D CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: /t(W— -7 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> .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� height <br /> Consultant ` <br /> Geologist ABOVE-GRCUND <br /> COMPt.ETfON cONLO Ct_mCN IY-I� cN <br /> SPECIAL PERMIT INFO. around Sufact <br /> proof <br /> Distance to sever line <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> ft. <br /> = a <br /> SAMPLING tlorai - c <br /> soden — <br /> Holding Temperature _ <br /> _ 9r, 1.1pack <br /> Method <br /> Screenin;Method _ <br /> :t. <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 <br /> Slot size — <br /> GROUTING Bags cement <br /> 6-5 Buckets bentonite <br /> Depth to water---6 ? 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 /> Type of method <br /> EH 29 29. <br />