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MONITORING WELL INSTALLATION REPORT <br /> Dater/, _ CONSTRUCTION <br /> Premise Address: n _ _ _ 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 /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: �• <br /> casing <br /> Driller. height <br /> Consultant—& � _ — Ir 7 ~ <br /> Geologist -" ` VT <br /> ABC+/:-GROUND CHS=Y-8CX <br /> =WLR-MN COMP!—=MN <br /> SPECIAL PER-NET INFO. Gcv nd Stxfacs <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ► _ , <br /> If yes, location and distance - fL <br /> SAMPLING slcited <br /> soman � <br /> 'G <br /> Holding Temperature r9MV81 Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - Fn <br /> IF <br /> ) <br /> = tt <br /> SPOILS <br /> Storage Method 1J/A 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/ a) <br /> Type of method <br /> EH 29 29 <br />