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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) (to) <br /> Inspector: Bentonite (from) (to) <br /> P 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 /> . <br /> Driller: --TT-- casing <br /> height <br /> Consultant <br /> Geologist _ <br /> I30VE-GROUND <br /> COI.FLETION CkiEi157'Y=80X <br /> SPECIAL PERMIT INFO. ��Surlxv CHRIS.E710N <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - h• <br /> ft. <br /> SAMPLING o <br /> Holding Temperature s4c5on <br /> Method gravel pads <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> ft. = <br /> SPOILS & <br /> Storage Method <br /> Contamination Noted - (y/n) MAT�ALS�EVELOPMENT <br /> Storage Location <br /> Casing type <br /> B1,_& Screen ft. <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed Surge Block; - (y/n) <br /> Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />