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MONITORING WELL INSTALLATION REPORT <br /> Date: v�-' 1� �} CONSTRUCTION <br /> Premise Address:4-x'07 Ab"G1OL,.►C}V-,r well No. <br /> Inspector: Total Depth <br /> Screen Length <br /> Filter Pack_ <br /> I Bentonite Pellets <br /> Permit No. "1 �J Grout `ZV' --I!:. - <br /> Consultant 5 Completion-Stove pi a/christie box <br /> Geologist GJI 71e7L - �} 57[,r <br /> Auger O.D.- <br /> Auger I.D. V4 <br /> SAMPLING <br /> Holding Temperature ` U $**-up <br /> Method / Icev— <br /> Screening Method Qyd <br /> A$ONE-GROUND CHRISTY-BOX <br /> Tracking Sheet (�jr n) COUPLETION COMPLEMN <br /> SPOILS around Surfacs .�� <br /> grout <br /> Storage Method eb�MA*A e <br /> Contamination Noted - 497no t5U0kV-_ <br /> Storage Location ft- <br /> OAJ v19rL�' ft. <br /> Iff <br /> P <br /> SPECIAL PERMIT INFO. <br /> e <br /> doitod _ <br /> Distance to sewer line s�ctlon <br /> Domestic well on site <br /> If yes, location & distance - r. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Z Casing type SU4 4 AIC. <br /> Ratios Blank IIL ft. Screen ft. <br /> Installation Method IL Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel Z•t fa `S _ <br /> Filter Pack type/size 0 30 SmVb <br />