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MONITORING WELL 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. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> Consultant height <br /> Geologist i T. <br /> ABOVE-GROUND <br /> CcmpL.,CN CS-fRlSrY BOX <br /> SPECIAL PERMIT INFO. Crnund Salac9 COMPLETION <br /> Distance to sewer line prat <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - n• <br /> ft — ft. <br /> = m <br /> F <br /> = m <br /> — c <br /> SAMPLING = <br /> slotted � <br /> •Qt'�On <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> tt. V <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <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 /> EH 29 29 Type of method <br />