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.t MONITORING WELL INST TION REPORT <br /> CONSTRUCTION <br /> Date: <br /> qq 9 �/• L.►/ Total Dcpth <br /> Premise Address, Screen Length (from) (to) <br /> ! Filter Pack (from) (to) <br /> Well No.: <br /> Bentonite (from)_ (to) <br /> Grout (from) (to) <br /> Inspector, Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/clu-istle box (circleone) <br /> Drilling Company: <br /> casing <br /> DriIIer•' he;ght <br /> • G Y 1 <br /> Consultant � <br /> Geologist A-'OVE-GnUNO ei+RGSTZ'-2AX <br /> CO W LF-T$O N CC+APL=-,ncN <br /> Grourd SLztacv <br /> SPECIAL PERMIT INFO. <br /> prcut <br /> Distance to sewer line <br /> Domestic well on site .- (y/ n} � <br /> If yes, location and distance - F � <br /> 0 <br /> &form <br /> SAMPLING sacicn <br /> Holding Temperature <br /> Method <br /> Screenin;Method <br /> Tracking Sheet - (y/ n) _ <br /> SPOILS <br /> MA' EPJALS/1) .OPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type ft <br /> Storage Location Blank ft• Screen <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gTavel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/11) <br /> Installation Method Discussed vrith geologist: - {y/ n} <br /> Quantity Installed - Type of mctllod <br /> EH 29 29. .._ . . <br />