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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from)' (to) <br /> Well No.: Filtet Pack (from) (to) <br /> Bentonite' (from) (to) <br /> Inspector: Grout (from) (to)___ <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion- Stove pipe/chnstie box (circle one) <br /> Driller: <br /> casing <br /> Consultant height ' <br /> Geologist <br /> ABOVE-G R OIMD <br /> cc wL mO N C IHRIM_Scx <br /> SPECIAL PERMIT INFO. COMPLEnoN <br /> C3round Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - <br /> - m <br /> SAMPLING = o <br /> a lotted — c <br /> t�on — <br /> Holding Temperature = <br /> Method "Vw pack <br /> Screening Method <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Method M_ ATERIALS/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-Ln-)-.--- <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 <br /> Type of method <br />