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• PAdfj_OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Well No. <br /> Inspector: Total Depth <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. Grout <br /> Consultant Completion-Stove pipe/christie box .. <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> ABOVE-GROUND CMAISTY-BOX <br /> Tracking Sheet (y/n) COWLGTION COMPLETION <br /> CtpundS <br /> SPOILS urlxs t <br /> Qrou <br /> Storage Method <br /> Contamination Noted - yes/no <br /> Storace Location ft. <br /> ' ft. <br /> M = <br /> 0 <br /> SPECIAL PERMIT INFO. — c. <br /> — c <br /> slotted = c <br /> Distance to sewer line udon — <br /> Domestic well on site - yes/no = <br /> If ves, location & distance - _ <br /> grays,Pack <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to :rater Casing type <br /> M i:< Ratios Blank ft. Screen ft. <br /> Installation Method Slot size <br /> Quant-"V Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> :)tal Billed Time Per Site <br /> ate Permit Finalized <br />