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MONITORING WELL INSTALLATION REPORT <br /> - ) CONSTRUCTION <br /> Date: (14i2 <br /> Total Depth <br /> Premise Address: Screen Length (from) (tO) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> II Grout (from) (to) <br /> Inspector:' Drilling rig type <br /> Auger O.D. LD. <br /> Permit No. Completion - Stove pip e/christie box (circle one) <br /> Drilling Company: �7 <br /> casing <br /> Driller: height <br /> Consultant <br /> Geologist ABOVE-GROUND CHRIM-Bpx <br /> COMPLETION COMPLETION <br /> Ground Surface <br /> SPECIAL PERMIT INFO. <br /> proal <br /> Distance to sewer line ft <br /> Domestic well on site - (y/n ) tt <br /> If yes, location and distance - ft <br /> u <br /> Jrt m <br /> _ e <br /> dottad <br /> SAMPLING <br /> wc7on <br /> Pack <br /> Holding Temperature _ �e 'I <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank g, Screen fr• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Surge Block: - (y/ n) <br /> Installation Method Discussed with geologist: - (y/n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />