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i �► <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Total Depth <br /> Premise Address: <br /> Screen Length (from) CCO) <br /> Filter Pack (from)�(to)— <br /> Well <br /> from) (to)Well No.: Bentonite (from)�(to)— <br /> Grout <br /> from) (to)Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/clu-isde box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: � height <br /> '9 <br /> Consultan <br /> Geologist ABOvF-GRCUND a-iszTy-BpX <br /> COWPL ETON COMPLETION <br /> Orourd Sulact <br /> SPECIAL PERMIT INFO. <br /> pfcut <br /> Distance to sewer line ,} it. <br /> Domestic well on site - (y/ rt) <br /> If yes, location and distance - R <br /> C <br /> O <br /> 1I0 n0� = C <br /> SAMPLING soden <br /> Holding Temperature <br /> Method _ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS <br /> MATERI ALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank ft. Screen— — <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ It ) <br /> Installation Method Discussed with geologist: - (y/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />