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MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: <br /> Total Depth (to) <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion • Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> Consultant T <br /> Geologist ABOVE-GaCUND CHR*7Y_a0X <br /> CCh4'LET CN C0MP1_=nCN <br /> ��.Ground Sumacs <br /> SPECIAL PERMIT ]NFO. <br /> prurt <br /> Distance to sewer line _.ft. <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft <br /> M <br /> O <br /> SAMPLING slorai <br /> tocicn <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) — <br /> tt. <br /> SPOILS <br /> MATERIALS, DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank fc. Screen —h <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravcl <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/n ) <br /> Installation Me[hod Discussed with geologist: - (y/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />