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MONITORING WELL INSTALLATION REPORT <br /> Date: 6b 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 /> Driller: _,._ casing <br /> height <br /> Consultant 'd <br /> Geologist •- <br /> ABCVE-G1gMND <br /> CC NFLETIO N CSW IM-a0X <br /> COMPL_°TICN <br /> SPECIAL PERMIT INFO. C�Z Ground SUiTf <br /> Distance to sewer line Qrcut <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft- <br /> o <br /> r <br /> SAMPLING <br /> tecicn <br /> Holding Temperature _ Ravi F <br /> Method <br /> Screening Method <br /> Tracking Shcet - (y/ n ) <br /> ft. <br /> t2- <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT o <br /> Contamination Noted - y n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> b Buckets bentonite <br /> Depth to water_ y/�, J 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 />