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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: Screen Length (from)' (to) <br /> Filter Pack <br /> (from) (to) <br /> Inspector: Bentonite' (from) (to) <br /> Grout (from) (to) <br /> Permit No. Dulling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: Completion- Stove pipe/chnstie box (circle one) <br /> Driller: <br /> casing <br /> Consultant <br /> height <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CHR ISTY-BOX <br /> SPECIAL PERMIT INFO COMPLETiON <br /> Ground Sartre <br /> Distance to sewer line orovt <br /> Domestic well on site - FY/n) <br /> If yes, location and distance - 1 It. <br /> = a <br /> — o - <br /> SAMPLING — c <br /> �btted — c <br /> Holding Temperature sac�on <br /> Method ; VzVW Pack <br /> Screening Method F <br /> Tracking Sheet - Cy/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen g, <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> InstallationMethod Filter Pack typesize <br /> Quantity Installed --------_Surge Block:=(_y_/n_)_ <br /> Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />