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MONITORING WELL INSTALLATION REPORT <br /> Date: CONS N <br /> Total Depth <br /> Premise Address <br /> Screen Length (from) (to) <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/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: F height <br /> '9 <br /> Consultant "I' <br /> Geologist ABQVE-GRCQNO v_nZ7Y_apx T <br /> OOWLETfON COMPLETION <br /> Ground Sact <br /> SPECIAL PERMIT INFO. <br /> Arad <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) tt. <br /> If yes, location and distance - n <br /> n. <br /> doral � <br /> SAMPLING sacicn <br /> Holding Temperature <br /> Method =' — <br /> Screening Method =_ <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank ft Screen —ft. <br /> Slot size <br /> GROLR7NG Bags cement <br /> Buckets bentonite <br /> Depth to waterBags sand/gravcl <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( / n ) <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br />