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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 Cfrom) (to) <br /> Inspector. Grout (from)—(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> casing <br /> height <br /> Consultant ` <br /> Geologist ABOVE-GRCUNO <br /> CONFLEf1ON C*MP Y30 <br /> CCt,1PLEi1CN <br /> SPECIAL PERMIT INFO. Ground S�'� <br /> Distance to sewer line PIZ <br /> grout <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft- <br /> ft. <br /> C <br /> O <br /> SAMPLING tlorod <br /> soc'cn - <br /> Holding Temperature —_ p avd Past <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank fr. Screenft. <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 /> 4pstallation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />