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PAGE OF 4 <br /> w . . <br /> MONITORING WELL INSTALLATION REPORT <br /> Date:) CONSTRUCTION <br /> Premise Address: 1446 Well No. W <br /> Inspector: MG0y0 Total Depth <br /> Screen Length <br /> Filter Pack - u 2 <br /> {�/� M� Bentonit e lets W <br /> Permit No. `7L-/ Grout mat <br /> Consultant &EtpjEe Com letion. ov , i chri ie box <br /> Geologist 066 u(5"E <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING -- <br /> sth*-up <br /> Holding Temperatur <br /> Method IL2,D-hJ,0 <br /> ,0 - <br /> Screening Method Nr:> "I F9 <br /> ABaVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y irn ll QOMPLE 1ON COMPLETION <br /> • around Surface <br /> SPOILS <br /> grout <br /> Storage Method - <br /> Contamination Noted - yes/no <br /> ft. n <br /> Storage Location•L- ,Q - c�h.tt�N,til11C3. ft <br /> - P <br /> SPECIAL PERMIT INFO. o <br /> � slottQd $ <br /> Distance to sewer line secpon <br /> Domestic well on site - yes <br /> If yes, location & distance - — <br /> GROUTING <br /> MATERIALS USED:- <br /> Depth to water � Casing type <br /> Mix Ratios Blank 970 ft. ScreeniA) _ft. <br /> Installation Method _ Slot size <br /> Quantity Installed Bags cement u <br /> Buckets bentonite S <br /> Bags an gravel <br /> Fiite ack type/size CZa <br /> Total Billed .Time Per Site Q(At {fit( <br /> Date Permit Finalized a �`"" at LW Q�(� <br />