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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) <br /> ,-,Inspector. <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> . <br /> Driller: casing <br /> iffT height <br /> Consultant ' <br /> Geologist RY <br /> 1" <br /> ABOVE-dROUND <br /> COWLETiON CNRISN=BOX <br /> SPECIAL PERMIT INFO. COMPL.E71ON <br /> Ground Surface <br /> Distance to sewer line orout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - 1 ft. <br /> ft ft. <br /> — o <br /> = m <br /> SAMPLING = o <br /> . alattad <br /> . aiCyOn 2 . <br /> Holding Temperature — <br /> Method = vn rei pxk <br /> Screening Method . <br /> Tracking Sheet - (y/n) ' — <br /> ft <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 /> Insallation Method Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> EH 29 29 Type of method <br /> T <br />