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ivioNITORING WELL INSTALLATION REPOR. <br /> Date: �8 CONSTRUCTION <br /> Premise Address: �( 6 Total Depth <br /> �/2 Screen Length (from) (to) <br /> Well No.: / Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: n-"� 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: ' o �' <br /> Z Driller: / casing <br /> height <br /> Consultant <br /> —Ew-f <br /> jvnf D AU- <br /> Geologist a •- <br /> ABOVE-GROUND <br /> COMPLETION C <br /> COOMPLETIMPLETI OX <br /> ON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> ft. ft. <br /> o <br /> SAMPLING slotted _ <br /> section = <br /> Holding Temperature = graw Pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> ft. ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <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 29 29 <br />