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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 <br /> (from) (co) <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 /> Driller: � Icaning <br /> IF— height <br /> Consultant <br /> Geologist <br /> ABOVE-GFRCUND <br /> CONFLETION C4_Gz'Y-80X <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Distance to sewer line prcut <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - (t. <br /> ftft. <br /> SAMPLING o <br /> Boned — c <br /> secicn '> <br /> Holding Temperature = <br /> Method = R+vd pads <br /> Screening Method =t <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 h. <br /> GROUTING Slot size <br /> 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 />