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MONITORING WELL INSTALLATION REPORT <br /> Date: LAL0 CONSTRUCTION <br /> Premise Address:_-?�.�� s Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: kt � 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 <br /> IEWT <br /> ABOVE-GROUND CHRMTY4 x <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlwo <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/n) _ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> aF q <br /> O <br /> SAMPLING alotted w' <br /> taction <br /> Holding Temperature = <br /> -w; gravel Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/nIF <br /> ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Bl� 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 />