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&NITORING WELL INSTALLATION REP* <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/clrristie box (circle one <br /> Drilling Company: <br /> Driller: casing height <br /> 'd <br /> Consultant <br /> Geologist /180VE GACUND CHRM•y-BOX <br /> COMPLETION COMPLfincN <br /> SPECIAL PERMIT INFO. Ground S 7-- <br /> proof <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) --ft. <br /> If yes, location and distance - N <br /> ft. <br /> - a <br /> =_ o <br /> -- o <br /> Monad <br /> SAMPLING sacicn <br /> Holding Temperature =_ tiT7fw Pack <br /> Method <br /> Screening Method "i = <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 />