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• • i A . <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonire (from)—(to)— <br /> Inspector: <br /> from) (to)Inspector: Grout (from) (to) <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 /> If <br /> T_ height <br /> Consultant ♦ <br /> Geologist T <br /> ABOVE-GACUND <br /> CC&FLr,CN cHsz7Ys3CX <br /> COWL=i 1CN <br /> SPECIAL PER_WT INFO. Ground Sutyy <br /> i <br /> Distance to sewer line grart <br /> Domestic well on site - (y/ n ) T <br /> If yes, location and distance - t. <br /> = a <br /> — a <br /> C <br /> SAMPLING = <br /> — c <br /> donad m <br /> sa=cn — <br /> Holding Temperature <br /> Method = 72VW Pack <br /> Screening Method ` = I <br /> Tracking Sheet - (y/ n ) = _ <br /> _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Cuing type <br /> Blank fr. Screen fr. <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 />