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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth_ <br /> Screen Length (from) (to) <br /> Well No.: �`� ��C Filter Pack (from) (to) <br /> �— Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. 1� Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION C-SISiY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft <br /> If yes, location and distance - <br /> ft. <br /> = m <br /> a <br /> — c <br /> SAMPLING — <br /> slotted <br /> socdon — <br /> Holding Tqrnperature =_ <br /> Method — Pack <br /> Screen' g Method = <br /> Trac g Sheet - (y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Cont anon Noted - (y/ n ) <br /> Stora Location Casing type VAA-t(Jt Ls <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water w ZV 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 />