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•MONITORING WELL INSTALLATION REPT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from)—(to)— <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/cluistie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant 1711 <br /> • � T <br /> Geologist T <br /> ABOVE-GACUND <br /> COMPLETION CHRISTY-a0X <br /> SPECIAL PERMIT INFO. G��g�xy COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) 7 ft. <br /> If yes, location and distance - <br /> h. <br /> ft. <br /> a _ m <br /> SAMPLING "— o <br /> clored — c <br /> sacicn - <br /> Holding Temperature = <br /> Method peva Fadt <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) ` _ <br /> ft. = IL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen fr. <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 />