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'MONITORING WELL INSTALLATION REPOkT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> 6 <br /> Well No.: <br /> Screen Length (from) .(to)— <br /> Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. "R Auger O.D. I.D. <br /> Completion - Stove pipe/c4lsfie box (circle one) <br /> Drilling Company: " <br /> a. <br /> Driller: casing <br /> height <br /> Consultant_ <br /> Geologist =- ABO,w <br /> VE-GROUND . <br /> COMPLETION CHRJSTY-BOX <br /> SPECIAL PERMIT INFO. � Geourd Solace COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) l <br /> If yes, location and distances _T ft. <br /> ft' T►- _ <br /> — a <br /> SAMPLING _ o <br /> slotted — c <br /> Holding Temperature <br /> Method — grs%,W 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 <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 Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />