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� J <br /> MONI'T'ORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: <br /> Total Depth <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) (to)� <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to)_ <br /> Inspector: Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion :Stove pipe/duistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller i IFm <br /> —:F hei_rht <br /> Consultant <br /> Geologist AYE-GRCUNO GrtASiY-3UX <br /> CAh'PLF ON CC+APL=—MCN <br /> C3rourxi SLriact <br /> SPECIAL PERMIT INFO. • <br /> flroc.•t <br /> Distance to server lined <br /> Domestic well on site .- (y/ n) {t, <br /> If yes, location and distance - <br /> Yw' X <br /> Q <br /> s1oC.ai :: _ � <br /> SAMPLING socicrn = <br /> Holding Temperature '> <br /> Method _ <br /> Screening Method <br /> Tracking Shcet - {y/ n) � , <br /> SPOILS <br /> MATERTALSZPEVEC.OPMENT <br /> Storage Method <br /> Contamination Noted- {y/ n} Casing type <br /> Storage Location Blank_ ft. Screen ft. <br /> Slot sue <br /> Bags cement <br /> GRounNG Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/n ) <br /> i,nstallation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />