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PA* CF <br /> MONITORING 'rlE'LL INS^'ALLATION REPORT <br /> Date:_lla� <br /> CONSTRUCTION <br /> Premise Address: Well No. <br /> Inspector:__[ Total Depth <br /> Screen Length l!�- <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. Grout <br /> Consultant aceto Completion-Stove pipe/christie box <br /> Geologist _ <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature xtick�p <br /> Meth,od_ <br /> --TF <br /> Screening Method ,« \ <br /> Tracking Sheet (v/n)n) ABOVE-GOUND <br /> V. !CC&VRaN <br /> ISPOILS CKound Surf acs <br /> grout <br /> Storage Method <br /> Contamination Noted - yes/no ft. <br /> Storage Location ,,,fib Z? ft. <br /> SPECIAL, PER-MIT INFO. — m <br /> slotted <br /> Distance to sewer line amen = B <br /> Domestic well on site - ves/no <br /> If yes, location & distance - Sn�vf pack i <br /> = i <br /> i <br /> GROUTING vC�� <br /> MATERIALS USED: <br /> Depth to watez)4�U Casing type a r`�y�SGL-yb <br /> Mix Ratios . . Blank ft. Screen ft <br /> Installation MethodSlot size 0.0 <br /> Quantity Installed^ D � Bags cement <br /> Buckets .benton-4te plc <br /> Bags sand/gravel <br /> .filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Pe?-T?t Finalized <br />