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RAGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: l�U� 11 CONSTRUCTION <br /> q n� <br /> Premise Add ss: 13� � �C� Well No. /''l w <br /> Inspector• Total Depth � S <br /> Screen Length "a <br /> Filter Pack <br /> I Bentonite Pe s 'P <br /> Permit No. 1r Grout 11), <br /> Consultant Completion-Stove. pipe/christie box <br /> Geologist <br /> Auger O.D. r'� <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature etk*-up <br /> Metho M TT <br /> Screening Method T <br /> AE&E-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> , a.� <br /> "" ` <br /> Storage Method gra <br /> ff�en <br /> �- i <br /> Contamination Noted - <br /> StoraqAe Location ft' <br /> �n. <br /> 'a <br /> e <br /> SPECIAL PERMIT INFO. <br /> l r ° <br /> �p slottod = c <br /> Distance to sewer line <br /> gQn <br /> Domestic well on site - yes no = gra�wpa* <br /> If yes, location & distance - <br /> s n = 35 n. <br /> GROUTING <br /> MATERIALS USED: <br /> a r <br /> Depth to water � � Casing type V'L <br /> Mix Ratios / /� Blank_ ft. Screen ?-D ft. <br /> Installation Metho Slot size QL <br /> Quantity Installed r7ags cement <br /> et-s- bentonite ) Y <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />