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MONITORING WELL INSTALLATION REPORT <br /> Date: (o�/�/ CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (ftn) (to) <br /> Drilling rig type /, ��r _ <br /> Permit No:-5�y—/ Auger O.D. I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company�iv 10��L �.� <br /> Driller: C �� 65S�j70 casing <br /> height <br /> Consultant 4U4, T <br /> Geologist <br /> AMVE-dROUND CHR*iY-80X <br /> COf fi'LEfION COMPLEMN <br /> SPECIAL PERMIT INFO. G=nd Suixs <br /> Distance to sewer line pry <br /> Domestic well on site - (y/n ) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> �is p <br /> C <br /> SAMPLING clotted <br /> �D� cec�on = -� • <br /> Holding Tempe ature ( = praysl pack <br /> Method <br /> Screening Method ff <br /> Tracking Sheet (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank If t. Screen ft. <br /> Slot size <br /> GROUPING Bags cement <br /> Buckets Y* geologist: - ( y/ n ) <br /> Depth to water Bags san <br /> Mix Ratios Filter Paze <br /> Installation Method Surge Bl / n ) <br /> Quantity Installed Discusse <br /> Type of <br /> EH 29 29 <br />