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PAGE OP <br /> MONITORING WELL INSTALLATION REPORT <br /> C-Iv <br /> 1D''ata: t r 11__ J � CONSTRUCTION <br /> Wd�j I,'C (� Sf a<kl /Y`er rtOh� t n <br /> PremisetA gess: well No. <br /> Inspector: Total Depth 2 <br /> Screen Length 3 i� <br /> Filter Pack <br /> Bentonite Pellets__ <br /> Permit No. C Grout ,S " S✓ <br /> Consultant Com plotion- <br /> -Stovesplpe Christie box <br /> Geologist 11 <br /> Auger O.D. A `` <br /> Auger I.D. G9 " <br /> SAMPLING <br /> Holding Temperature sock-up <br /> Method <br /> Screening Method <br /> ABOVE-GROUND C,HR&M-BOX <br /> Tracking Sheet (y/n) CONFLETION COMPLETION <br /> Qnx"Surface �� <br /> SPOILS <br /> groin <br /> Storage Method <br /> Contamination Noted - yes/no <br /> Storage Location40 <br /> n' <br /> .r <br /> SPECIAL PERMIT INFO. ;p <br /> Distance to sewer line <br /> Domestic well on site - yea/no qAf <br /> If yes, location & distance <br /> GROUTING j <br /> MATERIALS USED <br /> Depth to water Casing type <br /> yL {� <br /> Mix Ratios Blank f � ft. Screen ft. <br /> installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />