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MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: <br /> �?�Oh � Total Depth (to) <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company*.- <br /> casing <br /> Driller: 7— height <br /> Consultant <br /> Geologist po ABOVE-GRCUND <br /> C}-SiSTY-30X <br /> CoNFLETCN c4oWPLEEMN <br /> Ground Sulws <br /> SPECIAL PERMIT INFO. <br /> Ort <br /> Distance to sewer line _; <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - <br /> _- <br /> �� r <br /> _ a <br /> SAMPLING Tioczcn k3& <br /> :_ gcavvl pack <br /> Holding Temperature 49 <br /> Method <br /> 3L <br /> 2-* y <br /> Screening Method : <br /> Tracking Sheet - (y/ n) <br /> tt. <br /> SPOILS <br /> MATERIALS/DEVEIOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type ft <br /> Storage Location Bl ft. Screen---------ft <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 /> Installation Method Discussed with geologist: - (y/ n ) <br /> Quantity Installed Type of mediod <br /> EH 29 29 <br />