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MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br />? Date: <br /> Total Depth (to) <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) Qo) <br /> Well No.: Bentonite (from) (C0) <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. LD. <br /> Permit No. Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: he ±ght <br /> N <br /> Consultant <br /> Geologist AgoVE-GACUND et�tsl130X <br /> COMPLEC ON ` CCt,{PL• nCN <br /> Crwr� Sutac� <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sewer line _ ft. <br /> Domestic well on site - ( y / n ) ft. <br /> If yes, location and distance - tt <br /> a <br /> C <br /> ilorrni � c . <br /> SAMPLING tacicn <br /> Holding Temperature = <br /> Method <br /> l Screening Method <br /> Tracking Sheet - ( y / n ) <br /> SPOILS <br /> MATERI ALS/DEV ELOP MEET <br /> Storage Method <br /> Contamination Noted - ( y / n ) Casing type ft. <br /> Storage Location Blank ft. Screen <br /> Slot size <br /> Bags cement <br /> GROUTING <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water. Filter Pack type/size <br /> Mix Rados Surge Block: - ( y <br /> Installation Method Discussed with geologist: - ( y / n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />