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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: FIltet-Pack (from) (to) <br /> Bentonite' (from) (to) <br /> Inspector: Grout (from) (to) <br /> Dulling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion- Stove pipe/chnstie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist _ <br /> ABOVE-GROUND <br /> COMPLETION G-W15TY-80X .. <br /> SPECIAL PERMIT INFO. Greund gui2c* <br /> COMPLETION <br /> Distance to sewer line yroct <br /> Domestic well on site - (y/n) <br /> IF yes, location and distance - h• <br /> ft. <br /> — m - <br /> - o <br /> SAMPLING abttpd " = c <br /> Holding Temperature = <br /> Method s = 4r+ P <br /> Screening Method <br /> Tracking Sheet (y/n) ' — <br /> tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> GSlot size <br /> ROUTING <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method <br /> d ____ purge Block:=(.y/tea _ <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />