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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Ili <br /> Premise Address: <br /> Total Depth <br /> Well No.: Screen Length (from)�_(to) <br /> Filtet Pack (from) (to) <br /> Inspector: Bentonite' (from) <br /> Grout — (from) <br /> Permit No. Dniling-rigtype -Cfrf- (o) <br /> .._ - , <br /> Auger O.D. I D <br /> Drilling Company: Complet on- Stove pipe/christie box (c� one) <br /> Drillez: <br /> casing <br /> Consultant � height <br /> Geologist <br /> ABOVE-GROUND <br /> SPECIAL PERMIT INFO. CDFLETION C410�M-ScX ' <br /> COMPLETION <br /> Ground Surixa <br /> Distance to sewer line <br /> Domestic well on site - (y/n) grout <br /> If yes, location and distance - <br /> _ ft. <br /> SAMPLING _- m <br /> . clotted �- - � • <br /> Holding Temperature +acdcn <br /> Method :ri = <br /> Screening Method ` _ gram Pack <br /> Tracking Sheet - (Y/n) <br /> SPOILS <br /> Storage Method <br /> Contamination Noted - (—y/—n) MATERMLS/DEVELOPMENT <br /> Storage Location <br /> Casing type <br /> Blankft Screen <br /> GROUTING Slot size �ft <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios--------------- Bags sand/gravel <br /> Installation Mehod Filter Pack typesize <br /> Quantity Installed <br /> Discussed with geologist: - (y/n <br /> EH 29 29 Type of method <br />