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4 MONITORING WELL INSTALLATION REPORT <br /> I <br /> Date.• CONSTRUCTION <br /> IPremise Address: y well No. w � k <br /> Total Depth <br /> Inspector: i <br /> Screen Length a <br /> Filter Pack -5t� • -;t - I •U <br /> Bentonite Pellets WrS,o p'�Permit <br /> mo- <br /> Permit No. Y� �'� Grout s =d - , <br /> Consultant beM.145dZ � completion-Stove pipe/c istie leo <br /> Geologists _— <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLINl3 <br /> u G .tic-up <br /> t Holding Temperature <br /> Method t <br /> Screening Method <br /> ABOVE=GROUND CHRISTY4OX <br /> i Tracking sheety n) COMPLETION COMPLETION <br /> Ground Surly <br /> SPOILS <br /> gloat <br /> f storage Method� .lS�u �•i <br /> Contamination Noted <br /> Storage Location r_(WC10 ft. <br /> oe:l_ ON G119" - <br /> f m <br /> i <br /> SPECIAL 'PERMIT INFO. e <br /> f slotted <br /> Distance to sewer line[ section <br /> Domestic well on site f yes no _ qmvel pack <br /> If yes, location & distance <br /> � t <br /> GROUTING <br /> MATERIALS USED: <br /> I I �lrr Al� <br /> Depth to water - Casing type- T <br /> Mix Ratios r BlankL,&! ft. Screen Zd ft. <br /> Installation Method `Mi mI[� _ Slot size a• n <br /> Quantity Installed Bags cement <br /> Buckets bentonite 94 &446 <br /> Bags sand/gravel ' <br /> t Filter Pack type/size <br /> r <br /> s <br />