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. r <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (ro) <br /> Well No.: Filter Pack (from) (to) <br /> IJJ Bentonite (from) (to) <br /> Inspector. U K��� Q Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant 9 <br /> Geologist <br /> A80VE-GRCUND <br /> CGWL TION C;_S*TY-BOX <br /> CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground Sexy <br /> Distance to sewer line Oran <br /> Domestic well on site - (y/ n) 7 ft. <br /> If yes, location and distance - tt <br /> tt. <br /> m <br /> -- C <br /> SAMPLING — <br /> ilorai = � <br /> tocicn = <br /> Holding Temperature <br /> Method — sf1Y9I F <br /> Screening Method - <br /> Tracking Sheet - (y/ nIF) <br /> ft. <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 Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />