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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: <br /> Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filter Pack (from) (to)—' <br /> Inspector: Bentonite (from) (to)— <br /> Grout (from) (to) <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle a one)— <br /> Driller: <br /> casing <br /> Consultant height <br /> Geologist —WT <br /> ABOVE-GROUND <br /> COMPLETION GMM-SOX <br /> SPECIAL PERMIT INFO. 6COMPLETION <br /> rouM Surface <br /> Distance to sewer line <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - <br /> ' tt. <br /> tt. ft. <br /> nd. <br /> 9 <br /> O <br /> SAMPLING <br /> slotted _" c <br /> Holding Temperature sac5on <br /> Method = P <br /> Screening Method z <br /> ack <br /> Tracking Sheet - (y/n) c <br /> SPOILS <br /> Storage Method <br /> Contamination Noted - (y j n ) M—ATERIALS/DEVELOPMENT <br /> Storage Location <br /> Casing type <br /> Blank ft. Screen fr, <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity installed Surge Block: - (y/ n) <br /> Discussed with geologist: - (y/n ) <br /> EH 29 29 Type of method <br />