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MONITORING WELL, INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: Screen Length-(from)' (to) <br /> Filter Pack (from)_(to)- <br /> Inspector: <br /> from) (to)Inspector: Bentonite' (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion- Stove pipe/christie box (circle one) <br /> Driller: <br /> casing <br /> height <br /> Consultant <br /> Geologist _ <br /> ABOVE-GROUND <br /> cowLETION CMM-Sox <br /> SPECIAL PERMIT INFO. Groundgurtxy COMPLETION <br /> Distance to sewer line proof <br /> Domestic well on site • (y/n) <br /> If yes, location and distance - 1 n• <br /> n. <br /> n. <br /> n%e <br /> SAMPLING sb <br /> &- con 'r <br /> Holding Temperature <br /> Method <br /> Screening Method _ "l <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERLALS/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 typesize <br /> Installation Method Surge_Block:__(.y/n_)__ <br /> ----------- --- --- <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />