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MONITORING WELL INSTALLATION REPORT <br /> Date: 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 (from) (to) <br /> 7 Drilling rig type <br /> Permit No.�� > ��SAuger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller casing <br /> height <br /> Consultant <br /> Geologist AE, -GRCUND <br /> h�'L.�T{O N ChRSTY-30X <br /> CO <br /> GOf tPL=ET1CN <br /> SPECIAL PERMIT INFO. Ground Suiacs <br /> pfOut <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n) ft. <br /> If yes, location and distance - ft• <br /> tt. <br /> y. 0 <br /> C <br /> O <br /> SAMPLING iloroi <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) ~` -- <br /> tt. t2. <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/ n ) Casing type — <br /> Storage Location Blank ft. Screen <br /> Slot size — <br /> GROUT[NG Bags cement — <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel = <br /> Filter Pack type/size <br /> Mix Ratios <br /> J nstallation Method Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - (y/ n) — <br /> Type of method <br /> EH 29 29 <br />