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MONITORING WELL INST'ALLAnON REPORT <br /> Date: CONSTRUC'HON <br /> Premise Address: Total Depth <br /> Screen Length (from) (Co) <br /> Well No.: Filter Pack '(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: hasght <br /> e_c�ht <br /> Consultant 1 <br /> Geologist AZCVE•OFtCUyp <br /> COi4PL�MN ccv.>—=,n }X <br /> CrO�t,d'l�••TICN <br /> SPECIAL PERMIT INFO. Grcund Suisct <br /> �rcc.•t <br /> Distance to sewer line <br /> Domestic well on site - Cy/ n) II• <br /> If yes, location and distance - ft. <br /> SAMPLING �lar,d <br /> r <br /> socien <br /> Holding Temperature A "9t Pa.* <br /> Method =► <br /> Screening Method `*• <br /> Tracking Shcet {y/ n} <br /> �'ft. <br /> SPOILS <br /> Storage Method MATERiALS/DEVEI.OPMENT <br /> Contamination Noted - (y/n) Casing type <br /> Storage Location Blank ft. Screen_-------,ft• <br /> Slot size <br /> GROLTIING Bags cement <br /> Buckets bentonite <br /> Dego►to Crater Bags sand/gravcl <br /> Filter Pack type/size <br /> MU Ratios <br /> Surge Block: - (y/n <br /> 4pstallation Method ) <br /> Quantity Installed Discussed vAth geologist: - (y/n) <br /> Type of ncthod <br /> 8H 29 29 - <br />