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i <br /> MONITORING WELL INSTALLATION REPORT <br /> ks <br /> I <br /> Date.• I CONSTRUCTION <br /> i <br /> Premise Address: Well No. <br /> 1..� a' <br /> k <br /> Inspector- ;# ZATotal Depth <br /> Is Screen Length .6-'m <br /> Filter Pack -fZ2. <br /> Bentonite Pellets-/' S' <br /> Permit No. fig - Z Grout <br /> f Consultant p2co <br /> Geologist 'v'. completion-stove pipe ristie Eox' <br /> I Auger O.D. 10 <br /> 3AAuger I.D. fG <br /> M---PLiNG . <br /> Holding TemperatureC grid«-up <br /> Method T L-1 <br /> 1 . <br /> Screening Method <br /> Tracking Sheet On) ABOVE-GROUND CHRISTY-BOX <br /> COMPLETION COMPLETION <br /> SPOILS ���� <br /> Storage Method <br /> kAL9 LGrout <br /> Contamination Noted - yesft. <br /> Storage Location_ _ n. <br /> ...,.._eft. <br /> = m <br /> SPECIAL PERMIT INFO = <br /> ' o <br /> Distance to sewer line- .� >Woltod <br /> Domestic well on site - dyes <br /> If yes, location & distance - .:: gmwlpack <br /> GROUTING <br /> i <br /> MATERIALS USED: <br /> Depth to water. /7 Casing type <br /> Mix Ratiosi g <br /> Blank ,5 ft. Screen �ft. <br /> Installation Method _ S' slot size , G'�0 <br /> Quantity Installed Bags cement <br /> Buckets bentonite -Z- <br /> Bags sand/gravel /S <br /> Filter Pack type/size � <br />