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MONITORING WELL INSTALLATION REPORT <br /> Date: qj(0 Dpi CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.:_`�A ` �o, �1 Filter Pack (from) (to) <br /> VMA <br /> Bentonite (from) (to) <br /> Inspector: 0 VMXti Grout (from) (to) - <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Cultant <br /> Gedtog t/ �,n i t <br /> ABOVE-GROUND CHAIS7Y BOX <br /> COA3�LEf10N COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) tt <br /> If yes, location and distance - tt <br /> tt. <br /> O <br /> C <br /> SAMPLING slottad = c <br /> sacdon <br /> Holding Temperature = gravel P <br /> ack <br /> Method = <br /> Screening Method r <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 /> Type of method <br /> EH 29 29 <br />