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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 Park (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 /> Driller: casing <br /> in <br /> height <br /> Consultant <br /> Geologist <br /> AWVE-GROUND FS?Y-80X <br /> COf.1PLEf10N CHRCOMPLEnON <br /> SPECIAL PERMIT INFO. Ciracmd Sidi* <br /> Distance to sewer line <br /> IIroU# <br /> Domestic well on site - {y/n ) �tt. <br /> If yes, location and distance - . <br /> o:c b <br /> Q <br /> SAMPLING slo:tad — c <br /> Holding Temperature <br /> Method <br /> Screening Method ' — <br /> Tracking Sheet - (y/n } - <br /> SPOILS <br /> Storage Method MATERIALSZDEVELOPMENT <br /> Contamination Noted - (y/ n ] <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <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 Instal'_ed Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29 <br />