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C, <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> �ly CONSTRUCTION "' I <br /> prDa����( IJ2 ✓ Welo. <br /> Premise Addressl N <br /> : <br /> Inspector• Total Depth <br /> Screen Length Z Z — <br /> Filter Pack Z Z <br /> Bentonite Pellets <br /> Permit No. - Grout G11 'S - <br /> Consultant �����C ' /SC Completion-Stove pipe ristie box <br /> ----------------- <br /> GeologistyC It <i ;✓1 <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING — <br /> sock-up <br /> Holding Temperature <br /> Method T <br /> 7,ril <br /> T <br /> Screening Method .. <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y& COMPLETION COMPLETION <br /> Ground Surlaco <br /> SPOILS <br /> proal <br /> r <br /> 2 <br /> Storage Method bit S• %/5� ' n, <br /> Contamination Noted - yes�/9) n <br /> Storage Location <br /> a <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> slottod _ c <br /> Distance to sewer line vection <br /> Domestic well on site - yes/no = pravWpack <br /> If yes, location & distance - <br /> = ft. <br /> GROUTING <br /> J MATERIALS USED: Q <br /> Depth to water S7`iC - Casing type <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size 1 0 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size Z <br /> ion 7le ��'�� <br />