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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) Cto) <br /> Well No.: Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector: Grout (from) Cto) <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 /> Consultant 7 <br /> Geologist <br /> A80VEv^A0UND <br /> CCAPL`1_.0N CHMSTY3CX <br /> CCW_=1 TCN <br /> SPECIAL PERMIT INFO. G=r4 Surfaes <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - - t' <br /> _ fL <br /> K. <br /> a <br /> - � s <br /> s <br /> SAMPLING = –' <br /> ab[tad � <br /> sac:on - <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n) <br /> tL _ — ♦ }t- <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - C y/ n ) <br /> Storage Location Casing type <br /> Blank fc Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block. - (y/ n ) <br /> Quantity Installed Discussed with geologist-. - (y/ n) <br /> Type of method <br /> EH 29 29 <br />