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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> hPremise Address: ���� -1 ,.� l����� s�� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> /_'1 <br /> Bentonite (from) (to) <br /> Inspector: � Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cliristie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant ,,pp �l _ <br /> Geologist_ h-e� <br /> ABCVE-GACUND <br /> CCMPIETfON CNASSTY-80X <br /> COMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> rout <br /> Distance to sewer line g1 <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> �. ft. <br /> o <br /> �- M <br /> SAMPLING <br /> soden <br /> Holding Temperature = Ravi F <br /> ack <br /> Method _ <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> ft. <br /> ft. <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 />