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MONITORING WELL INSTALLATION REPORT <br /> S <br /> a <br /> P ' <br /> Date: <br /> CONSTRUCTION <br /> I <br /> } Premise Address: Total Depth <br /> Well No.: Sean Length (from) (to) <br /> + Filtet Pack (from) (to) <br /> Inspector: Bentonfte' (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/chn'stie box (circle one, <br /> Driller: <br /> casing <br /> Consultant height ' <br /> � Geologist <br /> ABOVE-GROUND <br /> COMPLETION CHA45TY BOX <br /> SPECIAL PERMIT INFO COMPLETION <br /> . (around suixe <br /> Distance to sewer line Qrart <br /> Domestic well on site - (Y/n) <br /> If yes, location and distance <br /> SAMPLING ' — o <br /> slotted — 2 <br /> s :a. <br /> x�on ; _ <br /> Holding Temperature M. _ <br /> MethodY;' _ pr,vs pack <br /> Screening Method = <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Method MATERLSLS/DEVELOPI EM <br /> Contamination Noted- (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen $_ <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 M_etho_d -Surge-Block: - (_y_/n_) <br /> Quantity Installed -- <br /> Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />