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•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 <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: hng <br /> eightheight <br /> Consultant -� <br /> Geologist - r <br /> ABCVE-GACOND Ctfii1STY80X <br /> COA?PLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sutaca <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) Ir <br /> If yes, location and distance - ' ft. <br /> � ft. <br /> a _ <br /> o <br /> SAMPLING donod <br /> sac7an <br /> Holding Temperature <br /> Method = <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 /> Type of method <br /> EH 29 29 <br />