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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)—(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant 47C6T- <br /> Geologist <br /> ABOVEI'iflCUND —Ew <br /> COMPLETION CHRISTY-Box <br /> SPECIAL PERMIT INFO. prd g�Yy COMPLETION <br /> Distance to sewer line 0roui <br /> Domestic well on site - (y/ n) �_ft, <br /> If yes, location and distance - <br /> ft. <br /> v. m <br /> SAMPLING tlotai — c <br /> soc'cn '- <br /> Holding Temperature = <br /> Method F"Cit <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 /> GSlot size <br /> ROUTING <br /> Bags cement <br /> Buckets bentonire <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ tt ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />