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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' (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion- Stove pipe/chn'stie box (circle one) <br /> Driller: casing <br /> Consultant <br /> height <br /> Geologist I <br /> 7 <br /> ABOVE-GROUND <br /> • COMPLETIoN CHMM-Sax <br /> SPECIAL PE � <br /> PERMIT INFO. Gr)d gudxy COMPLETION <br /> Distance to sewer line "rout <br /> Domestic well on site - (y/n) tt <br /> If yes, location and distance - <br /> tt. <br /> tt. <br /> SAMPLING = c <br /> . dotted <br /> Holding Temperature = Gr+ Pack <br /> Method <br /> Screening Method —_ <br /> Tracking Sheet - (y/n) _ <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 Pack type/size <br /> Installation Method_ <br /> Quantity lnstalled- Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />