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MONITORING WELL INSTALLATION REPORT <br /> Date:_ ��C//�J <br /> CONSTRUCT(O N <br /> Premise Address:_ 14(4 Total Depth <br /> Well No.: Screen Length (from) <br /> Filter Pack <br /> Inspector: Bentonite (from)--(to)--- <br /> Grout <br /> from) _(to)__ ____Grout (from) (to)�^ <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company. _, Completion - Stove pipe/christie box (circle one) <br /> Driller. <br /> casing <br />� <br /> Consultant � height- � <br /> Geologist '���( C?� <br /> ABO E-GRCUND <br /> CO VP LET;0 N C�-A:STY-30X <br /> SPECIAL PERMIT INFO com-u-ncN <br /> C�.round Su-i�cs <br /> Distance to server line . <br /> prcc; <br /> Domestic well on site.- (y/ n) . <br /> If yes, location and distance <br /> SAMPLING <br /> ItoCc� — c <br /> Holding Temperature sxicn = .� <br /> Method — <br /> `� <br /> Screening Method — <br /> Tracking Shcet - (y/ n ) :r = <br /> SPOILS J1. <br /> Storage Method MATERIALS/DEVEI OpMEN-r <br /> Contamination Noted - (y/n) - <br /> Storage Location <br /> Casing type . <br /> Blank—fr- Screen ft. <br /> GROLMNG Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> MiX Ratios Bags sand/gravel <br /> ipstallation Method Filter Pack type/size <br /> Quantity Installed Surge Block: - (y <br /> Discussed with geologist: <br /> EH 29 29. Type of mediod <br />