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• • <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 (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller. casing <br /> he±ght <br /> Consultant TIV <br /> Geologist <br /> ABCVE-GRCUND C>iRISiY80X <br /> 7/4 <br /> CX)hfPLETION COMPt.ETiCN <br /> SPECIAL PERMIT INFO. Ground SLUX1 <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - <br /> tt ft. <br /> = Q <br /> C <br /> SAMPLING glow <br /> toc'cn = <br /> Holding Temperature <br /> Method = <br /> Screening Method <br /> Tracking Shcet - (y/ n ) Al <br /> ft. <br /> SPOILS ('00eiA '0D b <br /> Storage Method MAI NT l <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank fr. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Rados 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 />