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MONITORING WELL INSTALJ'ATION REPOR'C'°r .� <br /> Date: <br /> CONSTRUCTION <br /> � � <br /> Premise Address: ` Total Depth <br /> Screen Length (from) (to) <br /> Well No.: "l� J Filter Pack (from) (to) <br /> f> Bentonite (from) (to) <br /> Inspector: �f _ 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 /> Dricasingller: - F he_ght <br /> IF <br /> Consultant <br /> t G .� <br /> Gealis f AZOVE-GFtM?ID CHR*TY_e'0X <br /> OONFLETIO N GOMPS...c n0N <br /> SPECIAL PERMIT INFO. turd Sufacy <br /> Distance to sewer line <br /> Domestic well on site - (y/ n It. <br /> If yes, location and distance - ft. <br /> Y� O <br /> w <br /> 4 <br /> SAMPLING slorn.� <br /> s4cicn •"'• <br /> Holding Temperature = p'sY14 F-ack <br /> Method <br /> Screenin;Method . <br /> Tracking Sheet - {y/ n) : <br /> a._..r-...tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n} <br /> Storage Location Casing type fc. <br /> gl� ft. Screen <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/ Il ) <br /> Quantity Installed Discussed with geologist: - (y/ n } <br /> Type of method <br /> EH 29 29 <br />