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MOTORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector: Drilling rig type <br /> Permit No. <br /> Auger O.D. I.D. <br /> Completion • Stove pipe/cluistie box (circle one <br /> Drilling Company: <br /> casing <br /> Driller: � 1L height <br /> Consultant 'T <br /> Geologist ABCVE•GACUND C4�RtM43OX <br /> CCt.FL.ETICN CCMPL—cMN <br /> SPECIAL PERMIT INFO. <br /> Oran <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft• <br /> n. <br /> O <br /> SAMPLING slorad = d <br /> soricn <br /> Holding Temperature Pack <br /> Method = <br /> Screening Method <br /> Tracking Shcet • (y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type fr <br /> gl� ft. Screen <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 />