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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: Screen Length (from)' (to) <br /> Filter Pack Cfromj" (to) <br /> Inspector: Bentonite' °C.'($ord) (to) <br /> Grout (from) (to) <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: Completion- Stove pipe/chn'stie box (circle one) <br /> Driller: <br /> casing <br /> Consultant <br /> height <br /> Geologist <br /> ABOVEGROUND <br /> COMPLETION CHRZ7Y$OX <br /> SPECIAL PERMIT INFO. Ground SurfCOMPLETiON <br /> xw <br /> Distance to sewer line grout <br /> Domestic well on site -TY/n) <br /> If yes, location and distance - _g <br /> • ft ft. <br /> j:F = <br /> b <br /> SAMPLING = c <br /> SIottid <br /> Holding Temperature sxyon <br /> Method ; = V+vst pack <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERLAIS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> GROUTING Slot size <br /> Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios k c <br /> Filter Pack typesize <br /> Installation Method Surge ck t_ iz n_) <br /> Quantity Installed -- <br /> Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />