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- MONITORING WELL.INSTALLATION REPORT <br /> CONST' UCTiON <br /> Date: /J `1 <br /> Total Depth (to) <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) (to) <br /> Well No: Bentonite (from) (to) <br /> Grout (from) (5o) <br /> Inspector. Drilling rig type <br /> Auger O.D. _ I.D. <br /> Permit No. completion- Stove pipe/clutsde box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> Consul[an[ .t %VT <br /> Geologist A°lJVE•GaCUND C-K :ZTY-50X <br /> COWt.E PON MAPLETiCN <br /> Cxxrzl Sutarr <br /> SPECIAL PERMIT INFO. fl at <br /> Distance to sewer line_- ft. <br /> Domestic well on site .- (y/ n) ft. <br /> If yes, location and distance - ft <br /> I = o <br /> 0 <br /> �larad -= <br /> SAMPLING seccn <br /> _ avd Pace <br /> Holding Temperature <br /> Screening Method <br /> Tracking Sheet - (Y 1 n) ft .p = ft. <br /> SPOILS <br /> MATERI ALS/DMI,OPMENT <br /> Storage Method <br /> Contamination Noted - (y/n) Casing type <br /> Storage Location Blank fr. Screener —f <br /> Slot size <br /> Bags cement <br /> GROUPING Buckets ben[onite <br /> Bags sand/gravcl <br /> Depth to water Filter Pack type/size <br /> Mik Rados Surge Block: - (y/tt) <br /> .installation Method Discussed vrith geologist: - (y/n) <br /> Quantity Installed Type of ncdtod <br /> EH 29 29. <br />