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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from)' (to) <br /> Well No.: Filtet Pack (from) <br /> (to) <br /> Bentonite' (from) (to) <br /> Inspector: Grout (from) <br /> (to) <br /> Drilling rig type ' <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion- Stove pipe/christie box (circle one) <br /> Domer' casing <br /> Consultant r height ' <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CI-W IM43OX <br /> SPECIAL PERMIT INFO COMPLETION <br /> Circund Swire <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/n) 1 <br /> If yes, location and distance - L_ft. <br /> ft ft. <br /> F <br /> - m <br /> SAMPLING = a <br /> elottad - — c <br /> sac9an :moi = <br /> Holding Temperature '=° — <br /> Method = gravel pxk <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> tt. = ft, • <br /> SPOILS <br /> ' 4 • <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen g. <br /> GROUTING Slot size <br /> Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method_ _$urge�lock:_(_y_/�na <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />