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MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Premise Address: �75' " Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) <br /> (to) <br /> p Benronite (from) (to) <br /> Inspector. �lG 'tel . Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/cluistie box (circle one) <br /> Driller: casing <br /> n height <br /> consultant AT� <br /> Geologist <br /> ABOVE-GRCUND <br /> CONFL.`TCN STY 20X <br /> SPECIAL PERMIT INFO. G=rd gufxy <br /> COW?UMCN <br /> Distance to sewer line prat <br /> Domestic well on site . (y/ n ) <br /> If yes, location and distance - It. <br /> • (t ft. <br /> — _ m <br /> = o <br /> SAMPLING <br /> ilonad c <br /> Holding Tempperasure r <br /> Method <br /> Screening Method <br /> Tracking Sheet - / n ) — <br /> tt. <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 <br /> Type of method <br /> EH 29 29 <br />