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ftNITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (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/christie box (circle one) <br /> Driller: casing <br /> height , <br /> Consultant —e <br /> Geologist T <br /> A80VE-GROUND <br /> COM?LET;CN C4-(A�M-80X <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> Distance to sewer line pout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft• <br /> ft. ft. <br /> CD <br /> _ a <br /> — m <br /> C <br /> SAMPLING <br /> Slotted — d <br /> aecton '— <br /> Holding Temperature _ P <br /> Method grarw <br /> ack <br /> Screening Method — <br /> Tracking Sheet - (y/n) _ <br /> tt. = I Fft. <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 /> Type of method <br /> EH 29 29 <br />