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�R <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: �� Total Depth <br /> Screen Length (from) (to)_ _ <br /> Well No.: 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 /> casing <br /> Driller• height <br /> Consultant <br /> Geologist ABQVE-GRCt ND CNR*-rY480X <br /> ooNFLETION c xApLencN <br /> SPECIAL PERMIT INFO.Surfaet <br /> Qrcut <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - � ft. <br /> eft. <br /> Y' m <br /> o:. r <br /> SAMPLING siot*ed <br /> ss<1cn <br /> Holding Temperature a. = Qravtil Fast <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> .a• <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) 'Z /LUv <br /> Storage Location Casing type J_ <br /> Blank, —fL Screen ft. <br /> Slot size <br /> GROLTTING Bags cement <br /> (} C4 Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios � � Filter Pack type/size l , <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: • (y/ n) <br /> Type of method <br /> EH 29 29 <br />