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MONITORING WELT.INSTALLATION 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 /> Permit No. Auger O.D. LD. <br /> Completion-Stove pipe/chrisde box (circle one) <br /> Drilling Company: <br /> Driller. casing <br /> fm7l, <br /> T <br /> height - <br /> Consultant T <br /> . T <br /> Geologist AC&E-GROUND <br /> CGI�t.ETION q`��TY-SOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO= C3=nd Sud <br /> Distance to sewer line praJt <br /> Domestic well on site- (y/n <br /> If yes, location and distance - M <br /> s. <br /> SAMPLING slored <br /> &*don <br /> Holding Temperature , pack <br /> Method — <br /> Screening Method , <br /> Tracking Sheet - (y/n) <br /> fL <br /> SP_ OILS <br /> Storage Method �,,,VI,ATERlALSlDEVELOPMENT <br /> Contamination Noted- {y/n) <br /> Storage Location Casinge <br /> Blank fL Screen __ �•. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />