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r <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: 2Lr b CONSTRUCTION Y <br /> Premise Address: 440 fly AV -- Well No. <br /> Inspector: Total Depth__ _ --5 - <br /> Screen Length �i^�!• =� ��S' <br /> Filter Pack <br /> f Bentonite Pellets_746W <br /> Permit No. Grout --� --!W- <br /> Consultant Completion-Stove pip Christie bo <br /> Geologist Keqj IoLq k]L� <br /> Auger O.D. /Q il <br /> Auger I.D. h A <br /> SAMPLING <br /> so*-Up <br /> Holding Temperature <br /> Method e <br /> Screening Method . D <br /> FT- <br /> ABOVE-GROUND CHRISTY•BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> Ground Surfact <br /> SPOILS <br /> grout <br /> Storage Method 91011 ZZ, <br /> Contamination Notedye no �ft. <br /> Storage Location n• <br /> dD <br /> SPECIAL PERMIT INFO. <br /> _ o <br /> Distance to-,eewer line � f mon <br /> Domestic well on site - yes no = gravW pack <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water. Casing type <br /> Mix Ratios q 5.-S&L_ Blank ft. Screen 5' ft. <br /> Installation Method '7 lw„ILr— Slot size 0'g20 (6J_h_111-?A Zt�� <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size t) <br />