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'AGE—LOF--�— <br /> MONITORING WELL INSTALLATION REPORT <br /> Date• AsAora CONSTRUCTION <br /> Premise Address: f.Y� it B well No. !✓ <br /> Inspecto Total Depth (a S ' <br /> f .. Screen Length S - '5U <br /> Filter Pack li <br /> c, Bentonite Pellets <br /> Permit No. ~� Cf Grout - <br /> Consultant Completion-Stove,. pip c ristie box <br /> Geologist <br /> Auger O.D. <br /> Auger T.D. <br /> SA14PLING _ - - <br /> Holding Temperature /rC G vo stick-up Wl <br /> Method✓ <br /> 7' <br /> Screening Method <br /> ...16 <br /> AH0VE-GROUND CHRIM-Box <br /> Tracking Sheet (y/n) COMPLETION <br /> COMPLETION <br /> Ground Surface <br /> SPOILS <br /> groutStorage Method ✓t/��lr l •-�. <br /> Contamination Noted - yea o ft. <br /> Storage Loc a 'on rft. <br /> — a <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> C <br /> Distance to sewer line slo $ <br /> Domestic well on site - yesdgr-1 Q� pack <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> s�� Pyc spy <br /> Depth to water Casing type 410 <br /> Mix Ratios Blank 7 C�2 ft. Screenft. <br /> Installation Method Slot size __ _ _ ► Q Z <br /> Quantity Installed Bags cement <br /> Buckets bentonite.___ _ <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalizedf�- <br />