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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Fittet Pack (from) (to) <br /> Bentonite <br /> Inspector: Grout (from) (t) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D, <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle <br /> Driller: <br /> casing <br /> Consultant <br /> height <br /> Geologist T <br /> ABOVE-GROUND T <br /> COMPLErIcN CHRtM-BOX <br /> SPECIAL PERMIT INFO Ground SuCOMPLETIOSurface �. <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - b. h <br /> fl. ft. <br /> n 0 <br /> C <br /> SAMPLING __ o <br /> cloned — c <br /> Holding Temperature <br /> Method <br /> Screening Method c ..•. <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen g, <br /> GROUTING Slot size <br /> Bags cement <br /> Ratios Buckets bentonite <br /> Mix Ra <br /> Depth to os water Bags sand/gravel <br /> 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 />