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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: <br /> Total Depth <br /> Well No.: Screen Length (from) (to)�_ <br /> Filter Pack (from) <br /> Inspector: Bentonite (from) <br /> Grout (from) <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> casing <br /> Consultant height <br /> Geologist <br /> ABOVE-GACUND <br /> COMPLETION CHRLM-BOX <br /> SPECIAL PERMIT INFO <br /> GroundCOMPLE MN <br /> Ground Surface <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft. <br /> ft. ft. <br /> m <br /> O <br /> SAMPLING o <br /> slotted c <br /> aaclon = a <br /> Holding Temperature = <br /> Method = V&VW Pack <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> Jt. = ft. <br /> SPOILS <br /> Storage Method M_ ATERIALS/DEVELOPMENI, <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen fr, <br /> Slot size <br /> iROUTING Bags cement <br /> Buckets bentonite <br /> �pth to water Bags sand/gravel <br /> x Ratios Filter Pack type/size <br /> ,allation Method Surge Block: - (y/ n ) <br /> ntity Installed Discussed with geologist: - (y/ n ) <br /> ) 29 Type of method <br />