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casing <br />t height <br />V <br />MONITORING WELL INSTALLATION REPORT <br />Date: <br />Premise Address: <br />Well No.: <br />Inspector: <br />Permit No. <br />Drilling Company: <br />Driller: <br />Consultant <br />Geologist <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPOILS <br />Storage Method <br />Contamination Noted. ( y / n) <br />Storage Location <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 />Completion - Stove pipe/christie box (circle one) <br />ABOVE-GROUND <br />COWL—MON CHRISTY-80X <br />COMPLETICN <br /> Grourzt Skews <br />grout <br />i4 pa <br /> <br /> ft. <br /> <br />MATERIALS/DEVELOPMENT <br />Casing type <br />Blank <br />Slot size <br />Screen ft. <br />GROUTING Bags cement <br />Buckets bentonite <br />Depth to water Bags sand/gravel <br />Mix Ratios Filter Pack type/size <br />Installation Method <br />Quantity Installed <br />Surge Block: - ( y n) <br />Discussed with geologist: - ( y / n) <br />Type of method <br />EH 29 29