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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 /> Bentonite (from)-(to) <br /> Inspector: Grout (from) (to)- <br /> .Drilling <br /> to).Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/rluistie box (circle one) <br /> Drilling Company: <br /> Driller: �� casing <br /> height <br /> Consultant _ <br /> Geologist ABOVE•GRCUND <br /> COWLETION C tSTY30 <br /> CCt&1PL_R10N <br /> SPECIAL PERMIT INFO. Grourd Sui"Y <br /> groutDistance to sewer line <br /> Domestic well on site - (y/ n) It. <br /> If yes, location and distance - ft. <br /> tt. <br /> w <br /> = O <br /> SAMPLING slorod <br /> socicn = <br /> Holding Temperature __ pavdF <br /> Method v = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENC <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type fc <br /> Blank ft. Screen <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 /> ,installation Method Surge Block: - (y/ n ) <br /> Quantity installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />