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MONITORING WELL INSTALLATION REPQRT <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) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: <br /> Driller: oas ing <br /> T_ height <br /> Consultant t 7 '4 <br /> �-q T <br /> Geologist T <br /> ASGVE-GRCUND <br /> OC)l4�LE7JOM C�t�.SfY�OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sudwo <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n)If yes,yes, location and distance - ft. <br /> ft. <br /> SAMPLING <br /> dorsi <br /> sot?cn <br /> Holding Temperature <br /> ack <br /> Method ova F <br /> .' <br /> Screening Method <br /> Tracking Sheet - {y/ n } <br /> ft. <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 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/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />