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I <br />casing <br />height <br />MONITORING WELL INSTALLATION REPOiti <br />Date: <br />Premise Address: J 2 G4el2//6--17 <br />CONSTRUCTION <br />Total Depth <br />Screen Length (from) (to) <br />Filter Pack (from) (to) <br />Bentonite (from) (to) <br />Grout (from) (to) <br />Drilling rig type <br />Auger O.D. I.D. <br />Well No.: <br />Inspector: <br /> / <br />Permit No. <br />Completion - Stove pipe/christie box (circle one) <br />Drilling Company: <br />Driller: <br />Consultant <br />Geologist 1/1-,-,) 11/W- <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n) <br />If yes, location and distance - <br />ABOVE-GRCUND <br />COMPLETION CHPISTY-BOX • <br />COMPLETICN <br /> Gcr SleaCIP <br />Walt <br />ft. <br />ft. <br />0 <br />0 <br />graval pack <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n) <br />slor.e4 <br />socicn <br /> Ito <br />SPOILS <br /> <br />Storage Method <br />Contamination Noted- ( y / n) <br />Storage Location <br />MATERIALS/DEVELOPMENT <br /> <br />Casing type <br />Blank ft. Screen ft. <br /> <br />GROUTING <br />Depth to water <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />Slot size <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - ( y / n ) <br />Discussed with geologist: - ( y / n ) <br />Type of method <br />EH 29 29