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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address:_Oq Y _ Total Depth <br /> / Screen Length (from) , (to) <br /> Well No.: /('��r 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 /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CHRISTY48OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfer <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - n• <br /> SAMPLING = c <br /> 0 <br /> slotted u; _ <br /> aec�on <br /> Holding Temperature <br /> Method "° _ grays!Pack <br /> Screening Method ; <br /> Tracking Sheet - (y/n) <br /> ' <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 /> r <br />