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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filter Pwdc-- (from).."..": (to) <br /> Inspector: Bentonite • (from)- (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion- Stove pipe/christie box (circle one) <br /> Drillez: casing <br /> Consultant <br /> height <br /> Geologist __ <br /> ABOVE-GfiCUND T <br /> CCMPLET)ON C}{A STY BOX <br /> SPECIAL PERMIT INFO. GCOMPLETION <br /> Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site . (y/n) <br /> If yes, location and distance - tt. <br /> • R tt. <br /> o - <br /> r <br /> SAMPLING = o <br /> alottad — c <br /> Holding Temperature <br /> Method _ _ pr„rel pack <br /> Screening Method <br /> Tracking Sheet - (y/n) y <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen g, <br /> GROUTING Slot size <br /> Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method <br /> Quantity Installed --= <br /> Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />