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MONITORING WELL.INSTALLATION REPORT R <br /> i <br /> yo <br /> Date: ; - CONSTRUCTION�. x r <br /> Premise Address: ` Total Depth <br />' Screen Length (from) (to) <br /> Well No..• r Fiiter:Pack , (from) (to) - <br /> `� r Bentonite (from)` (to) <br /> Inspector: '> Grout (from) (to) <br /> 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 /> T'he;ght E <br /> Consultant <br /> Geologist - <br /> ABOVE-GRCUND , G-R* Y-30X. <br /> CCYPLErION C4 APLE'TICN, <br /> SPECIAL PERMIT INFO. - Ground Suiace. <br /> pram <br /> Distance to sewer line _ <br /> Domestic well on site - (y/ n) '. f <br /> If yes, location and distance - : <br /> SAMPLING .4 4h <br /> s4c1cn <br /> Holding Temperature <br /> VIv9c pact <br /> Method . . . - <br /> - <br /> Screening Method r <br /> Tracking Sheet - C y/n ) <br /> SPOILS <br /> Storage Method MATERIALS EVEI.OPMENT - x <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/graveI "' <br /> Mix Ratios . ;Filter Pack type/size <br /> jnstalladon Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29 - <br />