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MONITORING WELL INSTALLATION REPORT <br /> Date: �_S CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to)_ S <br /> Well No.: Filter Pack (from) (to) 3 5' <br /> Bentonite (from) 1 (to) 13 <br /> Inspector: Grout (from)` (to) <br /> 2 Drilling rig type—n <br /> J <br /> Permit No. Auger O.D. D. <br /> Drilling Company`: a ox <br /> Completion - Stove pipe/ (circle one) <br /> Driller:_ _ ] casing <br /> Consultant height��-� <br /> Geologists L <br /> J1E&r:.GR0UND <br /> COMPLETION Ct-iALM43OX <br /> SPECIAL PERMIT INFO. GroundSurface <br /> Distance to sewer line pout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - 1 ft. <br /> m <br /> - O <br /> C <br /> SAMPLING slottQd = <br /> sac,jon <br /> Holding Temperature <br /> Method Pack <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT I c <br /> Contamination Noted - (y/ n <br /> Storage Location Casing type V v <br /> Blank ft. Screen ft. <br /> Slot size ate/ <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 /> EH 29 29 Type of method <br />