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MONITORING WELL INSTALLAMON REPORT <br /> Date: �� CONSTRUCTION <br /> Premise Addressjso Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> 11 � Bentonite (from) (to) <br /> Inspector _1� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: <br /> Driller: casfng <br /> height <br /> Consultant P\ '4 <br /> Geologist •. <br /> ABOVE-GACOND . CHRMTY43OX <br /> COMPLETION COMPLEnON <br /> PBCIAL PERMIT INFO Clrarnd Sumacs <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - it. <br /> qa » <br /> f 4 <br /> �f <br /> SAMPLING <br /> secicn <br /> Holding Temperature =_ <br /> Method w — V1 Pack <br /> Screening Method : — <br /> Tracking Sheet - {y/ n 7 <br /> - <br /> t{o� .Si= <br /> YL. M <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination :Voted - (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 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 />