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MONITORING WELL INSTALLATION REPT <br /> Date: CONSTRUCTTON <br /> Premise Address: Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout Mom)—(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist 4711 <br /> T <br /> ABOVEGRCUND CNAfSTY BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. GroundSurfaceCOMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - It. <br /> ft ft. <br /> SAMPLING o <br /> tlorod — c <br /> toc9cn '- <br /> Holding Temperature <br /> Method = gnvaiPack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank fr. Screen ft. <br /> GROUTING Slot size <br /> 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 />