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0 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from)—(to)- <br /> Well <br /> from) (to)Well No.: Filter Pack (from) (to) <br /> Bentonite (from)-(to)- <br /> Inspector- <br /> from) (to)InspectorGrout (from)-(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: _.,_ casing <br /> V height <br /> Consultant <br /> Geologist T <br /> ABOVE-GACUND cliRi _Sox <br /> COWLETICN cowpuncN <br /> SPECIAL PERMIT INFO. Gro"rd S rfxs T� <br /> Distance to sewer line PIN <br /> grout <br /> Domestic well on site - (y/ n ) 1L <br /> If yes, location and distance - tt <br /> tt. <br /> r <br /> C <br /> O <br /> SAMPLING tlorai <br /> socion — <br /> Holding Temperature = yr,Y94 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 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 /> Type of method <br /> EH 29 29 <br />