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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) <br /> (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 A OUND <br /> cowFLEfION CHRz'Y-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Cirvund Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) l <br /> If yes, location and distance <br /> SAMPLING — o <br /> slotted — c <br /> Holding Temperature = <br /> Method = 9MV91 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 ft. Screen {t, <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 <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 <br /> Type of method <br />