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-NITORING WELL INSTALLATION REPOR r <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (front) _(to)_ <br /> Well No.: Filter Pack (from) (to)_ -- <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permic No. Auger O.D. I.D. <br /> Complerion - Stove pipe/cliristie box (circle one) <br /> Drilling Cornpany <br /> Tcas i:hq <br /> Driller. ' ne,,;ht: <br /> ConsultantTr 7 F, <br /> Geologist <br /> AiCVE-GACUND c-stm-acx <br /> C &PLL CN CC+41pr,,�"TICt+t <br /> SPECIAL PERT INFO. Grx:M Six# r <br /> MI ��•– • <br /> groat <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> - w <br /> a <br /> SAMPLING <br /> sac:cn <br /> Holding Temperature r�avnl <br /> Method <br /> Screenin; Method <br /> Tracking Sheet - ( y/ n ) F _— <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - { y/ n ) <br /> Storage Location Casing type <br /> BIank fr- Screen �f- <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Death to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - { y/ n } <br /> Quanciry Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />