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MONITORING WELL INSTALLATION REPORT <br />Date: tio 7 <br />Premise Address: Total Depth <br />Well No.: 0, IV (// WI // 64/ 2.- Filter Pack (from) (to) <br />Screen Length (from) (to) <br />Bentonite (from) (to) <br />Inspector: Grout (from) (to) <br />Drilling rig type <br />Permit No. <br />Driller: <br />Consul <br />ABOVE-GROUND <br />COMPLETION <br />SPECIAL PERMIT INFO. <br /> <br />Grxxind Surface <br /> <br />CONSTRUCTION <br />Geologist /ij <br />Drilling Company: <br />fl <br />c4-e casing <br />height <br />Auger O.D. I.D. <br />Completion - Stove pipe/christie box (circle one) <br />CHRISTY-BOX <br />COMPLETION <br /> <br />Distance to sewer line <br /> <br />Domestic well on site - ( y / n) <br />If yes, location and distance - <br /> <br />SAMPLING <br /> <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br /> <br />SPOILS <br />Storage Method <br />Contamination Noted - ( y / n) <br />Storage Location <br />MATERIALS/DEVELOPMENT <br />Casing type <br />Blank ft. Screen <br />Slot size <br />ft. <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 29 29