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MONITORING WELL, INSTALLATION REPORT <br /> Date: _ CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: _-- -Filter pack (from) <br /> (to) <br /> Inspector: <br /> Bentonite (from) (to)— <br /> Grout (from) (to)_ <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/ch istie box (circle one) <br /> Driller: <br /> - - — I=1 casing <br /> Consultant <br /> height <br /> GeologistABOVE-GROUND <br /> CCWLETCN CHRZ Y-BOX <br /> SPECIAL PERMIT INFO COMPLE71CN <br /> Ground Suixa <br /> Distance to sewer line — oro <br /> ui <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft <br /> ---- ft. ft. <br /> SAMPLING _— <br /> slotted ,':; c <br /> Holding Temperature svc�on <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 <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Bags sand/gravel <br /> Mix Ratios <br /> Installation Filter Pack type/size <br /> Method - <br /> Surge Block: - (y/ n ) <br /> Quantity Installed _ Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />