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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> _r <br /> Premise Address: f bG Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> n O Bentonite (from) (to) <br /> inspector•. .ti-sX/( Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> he ±ght <br /> Consultant LJ - <br /> Geologist <br /> ABOVE-GACUND GFffilSTY30X <br /> COhFLETION CANPLETIQN <br /> SPECIAL PERMIT INFO. Ground S�'� Tom" <br /> Distance to sewer line great <br /> Domestic well on site - ( y / n ) tL <br /> If yes, location and distance <br /> tt. <br /> c <br /> SAMPLING rloro-d <br /> socicn <br /> Holding Temperature _ pivolPack <br /> Method = <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 ft• <br /> Slot size <br /> GROUTING V Bags cement <br /> / d S Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />