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PAGE OF j <br /> I <br /> f <br /> MONITORING WELL INSTALLATION REPORT <br /> Date. ��� �" CONSTRUCTION <br /> Premise Address:32.0_D f ti j�,l;�� Well No. 7-V&S - hn w �; <br /> inspector: Total Depth S' <br /> r. <br /> Screen Length -2o' <br /> Filter Pack <br /> Bentonite Pellets__!:?#' <br /> Permit No. �`Za � I fit.' y Grout <br /> Consultant i�c,le. c.06F.tC <br /> Geologist Completion p / <br /> ove pichristie box <br /> = <br /> Auger O.D. IR" <br /> Auger I.D. K "/," <br /> SAMPLING <br /> Holding Temperature sUck-up <br /> 'Method T7 T_ <br /> Screening Method <br /> Tracking Sheet (y/n) ABOVE-GROUND OOMPLUION GF�RISIY'80X <br /> COMPLETION <br /> SPOILS &wnd Sudwe <br /> grou! <br /> Storage Method Zx <br /> Contamination Noted - yes/noft. <br /> `Storage Location <br /> V <br /> SPECIAL PERMIT INFO. .'.� • <br /> -Distance to sewer line <br /> Domestic well on site - yes/nope x <br /> If yes, location & distance - : = Imp <br /> ft. tt. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Cae ing type--f- `-t R U _ t/f <br /> Mix Ratios Blank GU ft. Screen 2y r gt. <br /> InstAllation Method Slot size 0"110 " <br /> Quantity Installed Hags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit finalized <br /> ' h <br />