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* c <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: <br /> �a` L Filter Pack (from) (to) <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/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> 71, <br /> Geologist XEp -GPSD <br /> ChASTY 30X <br /> CO WP LETC N <br /> �T1CN <br /> MI <br /> SPECIAL PERT INFO. Ground Suiact <br /> rCut <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - <br /> ft. <br /> Y' <br /> M <br /> C <br /> SAMPLING ilor� <br /> Holding Temperature <br /> Method =t = <br /> Screening Method =_ <br /> Tracking Sheet - (y/ n) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVJELOPNENT ' Q� <br /> Contamination Noted - (y/ n ) �U 1 y - <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 2'129 <br />