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MONITORING WELL INSTALLATION REPORT <br /> Date: _ CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) _ <br /> Filter Pack (from) (to) <br /> Inspector: Bentonite (from) (to)___ <br /> Grout (from) (to)— <br /> Drilling rig type <br /> Permit No. _—_ Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> --- ��� casing <br /> Consultant <br /> -- height <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION C4_AIS7YW X <br /> SPECIAL PERMIT INFO COMPLETION <br /> QtDund Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft <br /> - = m <br /> SAMPLING '— <br /> iiottati _— c <br /> Holding Temperature s° '°n <br /> Method r <br /> ack <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 , <br /> GROUTING Slot size <br /> Bags cement <br /> Buckets bentonite <br /> Depth twater 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 /> EH 29 29 Type of method <br />