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0 6 <br /> 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: <br /> from) (to)Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cltristie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant V <br /> . T <br /> Geologist r <br /> ABCVE-GROUND CiiA15TY 80X <br /> CCh4�6ETK)N COMPLE'nCN <br /> SPECIAL PERMIT INFO. Ground SUrtact <br /> Distance to sewer line orour <br /> Domestic well on site - (y/ n ) �_.ft. <br /> If yes, location and distance <br /> R. <br /> y = m <br /> - w <br /> SAMPLING <br /> 0 <br /> slornd = � <br /> torien <br /> Holding Temperature = p,vdpadt <br /> Method — <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 Type of method <br />