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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 /> height <br /> Consultant <br /> Geologist ._ <br /> - ABOVE-GRCUND <br /> COMPLETION CHRISTY-BOX <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line _ grout <br /> Domestic well on site - (y/ n ) ft <br /> If yes, location and distance - <br /> — <br /> S. — a <br /> = m <br /> — c <br /> SAMPLING — <br /> slotted -: — c <br /> axon — <br /> Holding Temperatureack <br /> _ P <br /> Method — <br /> Screening Method "t _— <br /> Tracking Sheet - (y/ nIF <br /> ) __ — <br /> it. = IF <br /> SPOILS <br /> Storage Method _ MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage LocaCasing 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 /> Type of method <br /> EH 29 29 <br />