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MONITORING WELL INSTALLATION REP <br /> ORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: <br /> Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Inspector: Bentonite (from)�(to)_�_ <br /> Grout (from)�_(to)_�_ <br /> Permit No. Drilling rig type <br /> ComAuger O.D. I.D-��_ <br /> Drilling Company: pletion - Stove pipe/christie box (circle one) <br /> Driller- <br /> casing <br /> Consultant height <br /> Geologist <br /> ABOVE-GROUND <br /> SPECIAL PERMIT INFO. COAFIETION CHR*- 4ox <br /> Ground SauceC. _ <br /> Distance to sewer line •' <br /> Domestic well on site - (y/—n grout <br /> If yes, location and distance- <br /> ft <br /> ft. ft. <br /> tl <br /> tl <br /> SAMPLING <br /> slotted _ 9 . <br /> Holding Temperaturesec on B <br /> " _ <br /> Method _ <br /> — gravel pack <br /> Screening Method <br /> Tracking Sheet - (y/n) _ <br /> 4. <br /> SPOILS fL ft. <br /> Storage Method <br /> Contamination Noted - (y/n) MATERIALVDEVELOPMENT <br /> Storage Location -. <br /> Casing type <br /> Blank ft. Screen ft• <br /> GROUITNG Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack tYpe/size <br /> Quantity Installed Surge Block: - (y/n) <br /> Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />