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MONITORING WELL.INSTAII ATION REPORT <br /> Date• CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (From) (to) <br /> Inspector. Grout (from) {to) <br /> Drilling rig type <br /> 'AAuger O.D. I.D. <br /> Permit No. '+completion -Stove pipe/christle box (circle one) <br /> Drilling Company: <br /> using <br /> Driller. _ heLghe <br /> Consultant <br /> Geologist #BUve-GRCUND p.RtMgpX <br /> 00NIPLETION COMPLETION <br /> Ground SuriaG+ <br /> SPECIAL PERMIT INFO <br /> praR <br /> Distance to sewer line tt- <br /> Domestic well on site- (y/ n) ft. <br /> If yes,location and distance - � . <br /> rw M <br /> i� <br /> SAMPLING tlot:a+i :% <br /> M <br /> Holding Temperature <br /> Method -- <br /> Screening Method <br /> Tracking Skeet - {y/n) <br /> SP„_OILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n} Casing type <br /> Storage Location BlankL ft. Screen <br /> Slot size <br /> RG Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack typesize <br /> Mix Ratios Surge Block: - (y/n) <br /> installation Method Discussed with geologist: - (y/ n 3 <br /> Quantity Installed Type of method <br /> EH 29 29 <br />