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MONITORING WELL INSTALLATION REPORT <br /> � Date: /�l�S� �- <br /> �/ CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No... Ml //� <br /> �!/� Screen Length (from) (to) <br /> i p—�7 Filter Pack (from) (to) <br /> Inspector: fdl��w t (" 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�(circle one) <br /> Driller: casing <br /> Consultant height <br /> car �-�ciS WT <br /> ABOVE-GROUND <br /> COWLETION CHSZTY-BOX <br /> SPECIAL PERMIT INFO COMPLETION <br /> ��—Gnwnd SLoace <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - 1 h <br /> e <br /> SAMPLING o <br /> sit tied — c <br /> on <br /> Holding Temperature — <br /> Method _ -Pavel pack <br /> Screening Method <br /> Tracking Sheet - (y/n ) _ <br /> ft. Li = tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVEL/OPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type, <br /> Blank ft. Screen g, <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bento ite <br /> 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 />