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•MONITORING WELL INSTALLATION REPORT <br /> , 8 <br /> Date: / n I ' CONSTRUCTION <br /> Premise Address: 0 NMS Total Depth <br /> Well No.: S 7 Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Inspector: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (cir <br /> i i v" <br /> Driller: casing <br /> height ' <br /> Consultant JJ <br /> Geologist /� Y_ ' <br /> ABOVE-GACUND <br /> OONFLETION CHAIS7Y-80X <br /> SPECIAL PERMIT INFO. COMPLEnON <br /> ��.Ground Surface <br /> Distance to sewer line groat <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - _ft. <br /> — a <br /> — o <br /> SAMPLING = c <br /> Carted — 'c <br /> Holding Temperature saclan <br /> Method gmvw Pack <br /> Screening Method = <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 /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 <br /> Type of method <br />