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MONITORING WELL INSTALLATION REPT j <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) <br /> (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: casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> COkFLETION CHR7M_ScX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surlaca <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) l <br /> If yes, location and distance - S_ft. <br /> —ft ft. <br /> a <br /> m <br /> m <br /> SAMPLING tlotud <br /> tacton <br /> Holding Temperature = <br /> Method = Wt" 4 Pack <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 h. 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 /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />