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PAGE OF <br /> 1 . <br /> MONITORING WELL INSTALLATION REPORT <br /> 4 <br /> Date: Z� <br /> CONSTRUCTION <br /> Premise Address:3-206 Well Na. 3 <br /> Inspector: Total Depth / <br /> Screen Length -5"? (71 <br /> ` Filter Pack -5S+ (�a 0 <br /> Permit No. <br /> q6 -e6S�' Bentonite Pe, lets -SS (Z'� <br /> t Consultant 6-�tr & Grout <br /> Geologist d,�lC <br /> Completioni5tove pipe Christie box <br /> Auger 0.D. 1< <br /> Auger I.D. L� 4 <br /> SAMPLZXG — - <br /> Holding Temperature •tk*-up <br /> Method <br /> Screening Method 'T <br /> Tracking Sheet (y/n) ABOVE-GROUND CHRIS7Y-BOX <br /> COMPLETION COMPLETION <br /> SPOILS OrWrd Surface <br /> Storage Method <br /> grout <br /> Contamination Noted - yes/no <br /> I Storage Location_•. h. <br /> ...eft. <br /> •i' � a <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line <br /> Domestic well an site - yes/no sacd°n <br /> If yes, location & distance - . -=� gmvwP&* <br /> IF <br /> l <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water. Y, „ Ca ine �Q <br /> Mix Ratios g t Yp <br /> 81ankLIO ft. Screen ft. <br /> Installation Method Slot size p.DlO°' <br /> Quantity Installed Bags cement <br /> r Buckets bentonite <br /> j Bags sand/gravel <br /> Filter Pack type/size j <br /> Total Billed Time Per Site — <br /> .�f <br /> Date Permit Finalized <br /> I <br />