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• a <br /> MONITORING WELL INSTALLATION REPORT <br /> Date:_ CONSTRUCTION <br /> Premise Address: ��O�'� S i Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> / Bentonite (from) (to) <br /> Inspector: _l � Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling <br /> /� Completion - Stove pipe/cluistie box (circle one) <br /> Company: 65 <br /> Driller: lir1 casing <br /> ConsultanfYnJ 7- height <br /> ////p�' � '4 <br /> Geologist�/'u �- _ \ T <br /> ABCVEGACUND <br /> COh1P1-ETION CHRISTY-Sox <br /> SPECIAL PERMIT INFO. prourd CCMPLEnCN S�txy <br /> Distance to sewer line VIA grout <br /> Domestic well on site - ( y/ n ) ��ft. <br /> If yes, location and distance - <br /> ft. <br /> tt. _ <br /> SAMPLING = s <br /> slorai =, � <br /> soden <br /> Holding Temperature = gavoa <br /> Method <br /> Pack <br /> Screening Method ; <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 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 /> EH 29 29 Type of method <br />