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MONITORING WELL INSTALLATION REPORT <br /> Date: 3D CONSTRUCTION <br /> Premise Address: 0.7 - Total Depth <br /> Screen Length (from) (to)- <br /> Wel] No.:--M�L.�. Filter Pack (from) (to) <br /> Bentonite (from) (to)_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: <br /> casing <br /> height: <br /> Consultant ��J, �j <br /> T <br /> Geologist <br /> ABOVE-GROUND <br /> GOMPLEfION CHR*TY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n <br /> If yes, location and dist ft. <br /> fit. ft. <br /> .r; p <br /> SAMPLING moo` <br /> slattad ws — c <br /> sec�on <br /> Holding Temperature c2%A cd <br /> �• — <br /> r. 1 <br /> Method vet <br /> Screening Method, el [�_ _ <br /> Tracking Sheet n )- <br /> 4. <br /> SPOILS <br /> Storage Method SMATERIALS/DEVELOPMENT <br /> Contamination Noted - ( /� <br /> Storage Location Casing type L +' <br /> Blank ft. Screen ft. <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water / Buckets bentonite <br /> V �d (risme Bags sand/gravel <br /> Mix Ratios ►.l , Filter Pack type/ e <br /> Installation Metho Surge Block: - t% n ) <br /> Quantity Installed T Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />