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MONITORING WELL INSTALLATION REPORT <br /> Date• ✓� � ( a <br /> CONSTRUCTION / <br /> Premise Address: &ni�l <br /> � ell Na. <br /> — 14�71jl <br /> Inspector: I otal Depth_ /fs� <br /> Screen Length <br /> Filter PackT <br /> S` <br /> _ 57 (Bentonite Pellets <br /> Permit No. rout----,2,5 <br /> Consultant LeAiLe f;cice Completia Stove pipe hristie box <br /> Geologist r l u <br /> Auger Q.A. <br /> Auger I.D. <br /> Holding Temperature aUdc-up <br /> Method <br /> Screening Method T <br /> 1fOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y OOAAPLETION COMPLETION Sumacs <br /> SPOILS <br /> /� grout <br /> Storage Method cW 45A <br /> Contamination Noted'- yes/ �• <br /> Storage Location n• <br /> _ e <br /> SPE IAL PERMIT INFO. <br /> C <br /> Wonsd <br /> Distance to sewer line asctlon Ft <br /> Domestic well on site - yea/ <br /> dIp <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USEDr <br /> Depth to water Casing type--&L <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size„ ___— <br />