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'�\A0NITORING WELL INSTALLATION REPrnT <br /> Date: " 3 � D CONSTRUCTION <br /> Premise Address: � r " ' 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 rig type <br /> Permit No, Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> A( l ' i <br /> MAMcc casing <br /> height <br /> Consultant ' <br /> w <br /> Geologist A80VE-GAOUND <br /> - COMPLETION COMPL TIC14 <br /> COMPLETION <br /> SPECIAL PERMIT INFO. G=nd Stuiace <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) tt. <br /> If yes, location and distance <br /> ft. <br /> — Ca.I — O <br /> SAMPLING dotted <br /> taction — <br /> Holding Temperature = VIVEW Pack <br /> Method <br /> Screening Method z <br /> Tracking Sheet - ( y / n ) <br /> ft. = tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type <br /> Blank ft. 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 /> Installation Method Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />