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MONITORING WELL INSTALLATION REPT <br /> Date: /G CONSTRUCTION <br /> Premise Address:—X-(-Z 7 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. �K 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 <br /> height <br /> Consultant �—f— V <br /> _E <br /> Geologist_ �`�� �� T <br /> ABOVE-GROUND C M*1N-80X <br /> COMPLETCN COMPL.EMN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft. <br /> tt. <br /> v � O <br /> SAMPLING = a <br /> r = B <br /> socicn —_ <br /> Holding Temperature <br /> Method _ F--.* <br /> Screenin;Method <br /> Tracking Shcet - (y/n ) - <br /> �._._ft. '� = tL <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <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 /> Quantity Installed Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29 <br />