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•MONITORING WELL INSTALLATION REPT <br /> Date: 0 7 �� CONSTRUCTIO�N/ <br /> Premise Address. �� Total Depth V(iAj., <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: 1 _ 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: casing <br /> height <br /> Consultant � 1711 <br /> Geologist / T <br /> ABOVE-GACUND <br /> COWLETION CHRISTY-BOX <br /> SPECIAL PERMIT INFO. p,=nd SurfaceCCMPLETICN <br /> Distance to sewer line Oticut <br /> Domestic well on site . (y/ n ) <br /> If yes, location and distance - <br /> ft. <br /> tt. <br /> A _ m <br /> _ » <br /> SAMPLING = s <br /> dorsi _ � <br /> (/6G sacicn r =_ <br /> Holding Temper a = pavdpadt <br /> Method ((// <br /> Screening Method r-5 <br /> Tracking Sheet / n ) ` — <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank h. Screen ft. <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/ a ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />