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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: Screen Length (from) (to) <br /> ... ....-... . <br /> 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 /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> . <br /> Driller: <br /> casing <br /> height <br /> Consultant <br /> Geologist <br /> A80VE-GACUND <br /> OOMPLETION CHRZTyBOX ' <br /> SPECIAL PERMIT INFO. G=nd Saixa COMPLETION <br /> Distance to sewer line KA, grout <br /> Domestic well on site - (y/n ) <br /> KIA <br /> If yes, location and distance - ft. <br /> 211 <br /> m <br /> SAMPLING — o` <br /> Slotted — c <br /> a <br /> taction < — <br /> Holding Temperature = <br /> Method <br /> Screening MethodIL Tracking Sheet - (y/n) tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen fr. <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 /> EH 29 29 Type of method <br />