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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: _ Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> ,,Inspector: Grout (from) <br /> (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: T casing <br /> ♦4 height <br /> Consultant jIff <br /> rm <br /> Geologist IN <br /> ABOVE-GROUND <br /> COMFLET;0N CNRIS71 bOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surface <br /> Distance to sewer line grout+ <br /> Domestic well on site - (y/n) <br /> If yes, location and distance- ft, <br /> ft. tt. <br /> ;, _ •.: -a <br /> SAMPLIN <br /> slotted — c <br /> Holding Temperature i°`�O0 '3 <br /> Method ? _ grsval pac4 <br /> Screening Methodu = <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />