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MONITORING WELL INSTALLA'RON REPORT <br /> CONMUC'RON <br /> Date: <br /> / Total Depth <br /> Premise Address; <� Screen Length (from) (CO) <br /> Filter Pack (from) (to) _ <br /> Well No.: Bentonite (from) (CO) <br /> . Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: _ height <br /> Consultant /I <br /> Geologist A YE-GRG'ING cuISTY-aox <br /> oONVLETION Cc+APL-=TlCN <br /> Ground Sutact <br /> SPECIAL PERMIT INFO. proct <br /> Distance to sewer line _ ft. <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - <br /> 7e <br /> SAMPLING sa- icn <br /> Packr <br /> Holding Temperature =" <br /> Method <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> MATERIALS/DE�I.OPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type ft• <br /> Storage Location gl fc Screen <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/n ) <br /> ipstallation Method Discussed with geologist: - (y/ n) <br /> Quantity installed Type of method <br /> EH 29 29 <br />