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—MONITORING WELL INSTALLATION REPOrr <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from.) (to) <br /> Woll No.: Filter flack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: 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: <br /> Driller: casing <br /> heoght <br /> Consultant 7f, V <br /> _ir61Geologist <br /> ABCVE-ar'i-OUND C.}_F Z7Y-a0X <br /> COMPI.,ETiCN cOMPLEnoN <br /> SPECIAL PERMIT INFO. Growd Sulact <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n } lta <br /> U yes, location and. distance - - <br /> tt. <br /> ID <br /> c <br /> SAMPLING a <br /> clor.� G <br /> tac3Cn � <br /> Holding Temperature _ Ravi <br /> Method <br /> Screening Method =A= — <br /> Tracking Shcet - ( y/ n } <br /> SPOILS <br /> Storage Method MATERIALS/DEVT~I.OPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> BIank ft. Screen ft. <br /> Slot size <br /> GROUTING C, Bags cement <br /> / f lockets bentonite <br /> Depth to wets: y (� '7 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 /> Eli 29 29 <br />