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r i <br /> MONITORING WELL INSTALLATION REPORT <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 rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/cluisde box (circle one) <br /> Driller: Cas i nq <br /> 7 height <br /> Consultant �� `4 <br /> Geologist T <br /> ABOVE-GACUND <br /> OONFLEfbN Z1rY_CHAISTY 80X <br /> � <br /> SPECIAL PERMIT INFO. G �g�Y,y CCCN <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - <br /> ft. <br /> �4 <br /> Y' O <br /> SAMPLING = 3 <br /> slonai = <br /> soden <br /> Holding Temperature = <br /> Method = V"Pack <br /> Screening Method <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 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 />