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MONITORING WELL INSTALLATION REPORT <br /> Date• r.Z b CONSTRUCTION <br /> Premise Address: 47o7._.P �i�p;,lLr Well No. <br /> Inspector• Total Depth_ 7' _ <br /> 7 Screen Length <br /> Filter Pack �S_ 71 --:Ip "-S.4 f <br /> Bentonite Pellets =A7� _60 <br /> Permit No. g(� (7 Grout <br /> Consultant �j Completion-Stove pipe ristie box <br /> Geologist.)_. Linn_ OAK49 <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING _- <br /> Holding Temperature �- stIck-up <br /> Method /C <br /> Screening Vo hod T-ev <br /> •. <br /> AE&E4ROUND CHRISTY-BOX <br /> Tracking Sheet on} COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> proal <br /> Storage Method CDAf713WK 13),A) <br /> Contamination Noted - Egpno � • <br /> Storage Location n• <br /> 'ag <br /> P <br /> SPECIAL PERMIT INFO. c <br /> o <br /> Distance to sewer line man <br /> Domestic well on site - yes r- = �vW P <br /> If yes, location & distance - :> , <br /> ack <br /> it, tt. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casin t e �"1-� U OV t- <br /> g y <br /> Mix Ratios Blank ft. Screen 3 ft. <br /> Installation Method Slot size �•�/ <br /> Quantity Installed Bags cement_ <br /> Buckets bentonite—12A 0&&r <br /> Bags sand/gravel <br /> Filter Pack type/size y 3V AJ6 <br /> 1 <br />