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r <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: 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: TT casing <br /> height <br /> Consultant <br /> Geologist _ T <br /> ABOVE-GROUND <br /> COWLETION C_[R SM-BOX <br /> COMPLET ON <br /> SPECIAL PERMIT INFO. Ground SLwfacs <br /> Distance to sewer line Cry <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - R- <br /> ft. <br /> — o <br /> = m <br /> — c <br /> SAMPLING = <br /> slortad — c <br /> socton — <br /> Holding Temperature _ P <br /> Method — <br /> Screening Method — <br /> f <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 fr. <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 />