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MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: 1 <br /> Total Depth <br /> Premise Address: Screen Length (from) (to) <br /> AAq Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector•. 1 Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: 11 1 F height <br /> '9 <br /> Consultant v <br /> Geologist R Aj&E-GRCUND G4-ttsTY-3oX <br /> CONFLETCN CoMPL-=MCN <br /> Ground Suiacs -- <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - <br /> O <br /> SAMPLING socicn <br /> Holding Tempera e 7 =_ <br /> Method <br /> Screening Metho _ <br /> Tracking Sheet n) <br /> SPOILS <br /> Storage Method �� <br /> R s y MATERIALS/DEVELOPN ENT <br /> Contamination Noted - (y .ci Casing type <br /> Storage Location ( Blank ft. Screen ft <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water, �L Filter Pack type/size <br /> Mix Ratios — Surge Block: - (y/ n ) <br /> Installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />