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MQNTTORING WELL INSTALLA'nON REPORT <br /> CONSTRUCTION <br /> Date: <br /> 07 <br /> Total Depth (from) <br /> Address: Screen Length ( <br /> Premise <br /> • Filter Pack ( <br /> Well No.: Bentonite (from) <br /> Grout (from) <br /> Inspector: Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company <br /> casing <br /> height <br /> Driller', ` <br /> Consultant <br /> Geologist �+ ABOVE-GSCUND .STY-a0X <br /> ppypLE ION GOMPtLmCt1 <br /> C#rourd s�faca <br /> SPECIAL PERMIT INFO. pra.K <br /> Distance to sewer line ft. <br /> Domestic well on site .- (y/ n) ft. <br /> If yes, location and distance - <br /> FS <br /> V„ M <br /> � C <br /> O <br /> SSANG sacicn <br /> pack <br /> Holding Temperature 'c <br /> Method <br /> Screening Method <br /> Tracking Sheet - (Y <br /> SPOILS <br /> MATERIALS EVEt.OPMENT <br /> Storage Method <br /> Contamination Noted- (y/ n) Casing type fr. <br /> Storage Location Blank ft. Screen <br /> Slot size <br /> Bags cement <br /> GRA G Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ n) <br /> installation Method Discussed vrith geologist: -( y/ n) <br /> Quantity installed Type of method <br /> EH 29 29- <br />