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• <br /> *MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) <br /> (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/cliristie box (circle one) <br /> Driller: -. casing <br /> height <br /> Consultant <br /> Geologist ,_ �► <br /> NBCVE-GACUND CNAISTY-BOX <br /> COAR�LlTION COMPt,ET1CN <br /> SPECIAL PERMIT INFO. Ground Surfscs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - 8 (3 ft . (7- <br /> -ft. <br /> Z---°--h• )J:� <br /> I•% Y NHH. <br /> SAMPLING <br /> 3 s <br /> aacicn <br /> Holding Temperature <br /> Method gnvw Pack <br /> Screening Method — <br /> Tracking Sheet - (y/ n ) — <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type �/ V(.i <br /> Blank ft. Screen ft. <br /> Slot size 7-0 2_0 <br /> GROUTING Bags cement <br /> Buckets bentonite G <br /> Depth to water Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/siz � <br /> Installation Method Surge Block: - ( y/ Il) <br /> Quantity Installed <br /> Discussed with geologist: - (y� n ) <br /> EH 29 29 Type of method <br />