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9 0 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: � /y�l CONSTRUCTION <br /> Premise Address: S Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack <br /> / (from) (to) <br /> Inspector. ��(� �I 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/cluistie box (circle one) <br /> Drillers casing <br /> ' �� height <br /> Consultant"" / - <br /> Geologist�ec��� '' �/tit�7iS _ <br /> ABCVE-GACUND <br /> CCWLETION G'SISIY-3oX <br /> SPECIAL PERMIT INFO CCMPL.�TICN <br /> CYound Suixa <br /> Distance to sewer line Oran <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft, <br /> • tt tt. <br /> SAMPLING c <br /> tloc',nd — c <br /> soricn _ <br /> Holding Temperature — <br /> Method - = p+wt Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> tt. tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank fr. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Depth to water Buckets bentonite <br /> Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ rt ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />