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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONS�ON <br /> Premise Address: <br /> Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filtet Pack (from) (to) <br /> Inspector: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Permit No. Drilling rig type <br /> Auger O.D.—LD.— <br /> Drilling Company: Completion - Stove pipe/christle box (cir <br /> Driller: <br /> — casing <br /> Consultant height <br /> Geologist <br /> ABOVE-GROUND <br /> COWLEToN C8RZ Y-80X <br /> SPECIAL PERMIT INFO. <br /> GroundCOMPLETION <br /> nund Surface <br /> Distance to sewer line <br /> Domestic well on site - FY/n) grout <br /> If yes, location and distance <br /> ft- ft. <br /> 's- _ <br /> SAMPLING <br /> v slotlad �' — c <br /> Holding Temperature I mon ? <br /> Method <br /> Screening Method _ ...' <br /> Tracking Sheet - (y/n) <br /> SPOILS . <br /> Storage Method RIALS EVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casin type <br /> Blank fr. Screen ft, <br /> GROUTING ` Slots' e <br /> Bags c mens <br /> Depth to water OBuck bentonite <br /> Mix Ratios Bag sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed Surge Block: - (y/n ) <br /> D' ssed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />