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MONITORING WELL INSTALLATION REPORT --- <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: 6 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) <br /> (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 /> Driller: casing <br /> height <br /> Consultant7 <br /> Geologist •- <br /> ABOVE GROUND Ct Rtm-80% <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Six+ <br /> Distance to sewer line orrsx <br /> Domestic well on site - (y/n) n. <br /> If yes, location and distance - n. <br /> n. <br /> . A _ <br /> X' C <br /> O <br /> SAMPLING a ottad <br /> LQC�on rp <br /> Holding Temperature _ ': gnva{pack <br /> Method <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 fr. <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 /> Type of method <br /> EH 29 29 <br />