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0 0 <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 /> Bentonite <br /> from) (to)Bentonite (from)—(to)- <br /> Inspector: <br /> from) (to)Inspector: Grout (from)—(to)- <br /> Drilling <br /> from) (to)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 <br /> Geologist <br /> ABCVEvACUND <br /> CCA�r TAN CtWISY-BOX <br /> CCW_-TICN <br /> SPECIAL PERMIT INFO. Ground Surfaer r <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - ft. <br /> fL <br /> _ = m <br /> c <br /> SAMPLING dattad <br /> s�cdon - <br /> Holding Temperature <br /> Method — ¢'� ` <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> n _ ♦ tL <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 Park typesize <br /> Installation Method Surge Block: - ( y/ a) <br /> Quantity Installed Discussed with geologist. - (y/ n) <br /> Type of method <br /> EH 29 29 <br />