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ii <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: Total Depth <br /> />tiW _ 10 Screen Length (from) (to) <br /> Well No. : Filter Pack (from) (to) <br /> j Bentonite (from) (to) <br /> Inspector: j� 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 /> Driller: casing <br /> height <br /> Consultant RC i <br /> GGlegist r <br /> ABOVE-GROUND CHAlS7Y80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO, Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) 1 ft <br /> If yes, location and distance - <br /> ft <br /> ft. <br /> i — o <br /> a <br />' — m <br /> I — c <br /> SAMPLING ebtted <br /> o� sec4on <br /> Holding Tempe <br /> Method U ZZI OWL gms' Pack <br /> Screening Method (� <br /> Tracking Sheet - ( n ) <br /> ft. — fL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y rn <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUPING 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 />