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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from)—(Eo)- <br /> Well <br /> from) (to)Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig a /nuts Re4 — <br /> Permit No. Auger O.D.� ST4 D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: caeinq <br /> height <br /> Consultant ` T <br /> T <br /> Geologist A80 -GRC:UND <br /> COWLETCN c &tpunc <br /> CoMPL_�TIN <br /> CN <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ��ft. <br /> If yes, location and distance - tt. <br /> tt. <br /> yi. <br /> - = o <br /> i <br /> SAMPLING SOIL V tw.a�y/�n .lorai <br /> �l socicn _ <br /> Holding Temperature = pavd F"CR <br /> Method =_ ' <br /> Screening Method — <br /> Tracking Sheet - (y/n ) _ <br /> tt, = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) q,pqu )c _ 'go <br /> Storage Location casing We <br /> u ft. <br /> Blank fr. Screen IOT <br /> Slot size 0.0to <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios(�• ah"A Filter Pack type/size Y <br /> e[hod Surge Block: - (y/ n ) <br /> itts[allation M <br /> Quantitylns eEh Discussed v4th geologist: - (�}�/ n) <br /> Type of method V <br /> EH 29.29 <br />