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MONITORING WELT.INSTALI.ATtON REPORT <br /> CONSTRUCTION <br /> Date: <br /> Total Depth <br /> Premise Address: screen length (from) (toL <br /> Filter-pack {From)Well Bentonite No.: Bentonite (from) <br /> Grout tfrom) (to) <br /> Int ector. Drilling rig type <br /> Auger O.D. <br /> P I.D. <br /> Permit No. Completion - Stove Pipet <br /> cluisrse box (circle ane) <br /> Drilling Company: <br /> • cas;ng <br /> Driller.• , FM <br /> he?ght <br /> .y <br /> Consultant <br /> Geologist AYE-GROUND Y-3oX <br /> cc)YPL TION cohtpu- nck <br /> G=rid Sutac� <br /> SPECIAL pEFtMiT IN FO• Pratt <br /> Distance to sewer line <br /> Domestic well on site = {y/ n} �. <br /> if yes, location and distance - <br /> 0 <br /> a <br /> sloC�i ; <br /> S�G soczcn :=r <br /> Holding Temperature <br /> Method V. <br /> Screening Method s: <br /> Tracking Sheet -'(y/ n <br /> Spot _ � NIATEwAI,s�DE�I�oPMErrr . <br /> Storage Method <br /> Contamination Noted- C Y/ nCasing type E <br /> Storage I,ocadon Blank fr. Screen <br /> Slot size <br /> Bags cement <br /> GR�NG Buckets bentonite <br /> • Bags sancVSravel <br /> Depth to water Filter Pack type/size <br /> Mut Ratios Surge Block: - (Y/n) <br /> Apstallation Method Discussed vrith geologist: - (Y/n} <br /> Quantity installed Type of ncdiod <br /> EH 29 29- <br />