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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: <br /> Screen Length (from) (to)________ <br /> Filter Pack (from) (to)__ <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) <br /> (to)_ <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> . <br /> Driller: <br /> casing <br /> height <br /> Consultant • <br /> Geologist .' <br /> ASOVE-GROUND <br /> CO&PLETCN C4-(R1STY-BOX <br /> SPECIAL PERMIT INFO. QCOMPLETION <br /> iound Surface <br /> Distance to sewer line gran <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - _n, <br /> ft. <br /> ff. r_ _ <br /> m <br /> = a <br /> SAMPLING — o <br /> slotted _ c <br /> &?#cion — <br /> Holding Temperature <br /> MethodZi. = praval petit <br /> Screening Method <br /> Tracking Sheet - (y/n ) — <br /> SPOILS �l <br /> Storage Method 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/n) <br /> EH 29 29 Type of method <br />