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rrs <br /> t <br /> MONITORING WELL INSTALLATION REPORT <br /> Date.— <br /> CONSTRUCTION <br /> t <br /> Premise Address: &01? Well No. <br /> Inspector: A ( Total Depth <br /> Screen Length C(. <br /> Filter Pack e 66 f' <br /> 2 Bentonite Pel to 1 <br /> Permit No. '��J Grout -� Q <br /> Consultant U�41Z�r�C; Completion--Stove pip /christie boas <br /> Geologist Z <br /> Auger O.D. 70 IRL <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperaturestick-up_ � C� <br /> MethodIT7T <br /> 1 <br /> Screening Method <br /> ABOVE-GROUND <br /> Tracking Sheet (Y>) COMPLETION CHRISTY-BOX <br /> COMPLETION <br /> SPOILS s Grout d BWaGr f <br /> P <br /> Storage Method Y - l.(, (f- <br /> grout <br /> O <br /> Contamination Noted - yes no <br /> Storage Location tt. <br /> OLAft Im 1 r l 1. <br /> ft. <br /> m <br /> a <br /> SPECIAL PERMIT INFO. <br /> } C <br /> � � O <br /> Distance to sewer line dotlod _ <br /> action r <br /> Domestic well on site - yes1ED <br /> If yes, location & distance - :. = tmvwPxkLL <br /> r <br /> i <br /> GROUTING <br /> MATERIALS USED- <br /> Depth to water ;�j <br /> 7 3 Casing type qr. ( 41) �V <br /> Mix Ratios �� B1ank S ft. Screen �t. ; <br /> Installation Method '< � Slot size <br /> Quantity Installed Bage cement— <br /> Buckets <br /> 9G <br /> Buckets bentonite_ <br /> Bags sand/gravel <br /> Filter Pack type/size ] <br />