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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: 01 <br /> W41)) Total Depth <br /> Screen Length (from) (to) <br /> Well No.: A- Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: W��W Grout (from) (to) <br /> Drilling rig type <br /> Permit No. J Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant T <br /> GeologistV <br /> Ali�VE-GRCUND CHRtM43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Gmund Surlace <br /> bnd Suli + <br /> Distance to sewer line --rout <br /> Domestic well on site - y n <br /> ft. <br /> If yes, location and distance - <br /> ft. <br /> Ld <br /> SAMPLING <br /> slotted <br /> Holding Temperature <br /> Method <br /> ik- <br /> Screening Method <br /> Tracking Sheet y n <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n <br /> Storage Location- Casing type <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to waterLo 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 />