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i <br /> 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- <br /> from) (to)InspectorGrout (from)-(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant Vr <br /> _Q <br /> Geologist _ V <br /> ABOVE-GROUND CARS Y-8CX <br /> COMPLETIkPLETION CCMPL`nCN <br /> SPECIAL PERMIT INFO. Ground Surfact <br /> Distance to sewer line Oran <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance • tt. <br /> ft. <br /> 4. <br /> SAMPLING = ° <br /> slotted = <br /> suc'cn <br /> Holding Temperature _ RsvW <br /> PaCK <br /> Method — <br /> Screening Method <br /> Tracking Sheet - (y/ n ) — <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted . (y/n ) <br /> Storage Location Casing type <br /> Blank ft. 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/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />