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4 <br /> MONITORING WELL INSTALLATION REPORT <br /> Datey� ONSTRUCTION <br /> Premise Address:. l� � � ✓may✓�� Well No. 2✓ 2— <br /> Inspector: / �otal Depth / <br /> Screen Length_ . IP -7 _ <br /> Filter Pack <br /> C Bentonite Pellets - <br /> Permit No. Grout <br /> Consultant 4e- e - r Comp lot io .Stove i ristie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature edek'up <br /> Method 4111 <br /> Screening Method <br /> ABOVE-GROUND CHRISTY43OX <br /> Tracking Sheet (y/> COMPLETION COMPLETION <br /> (% Ground Sudwe <br /> SPOILS <br /> 9rou1 <br /> Storage Method LCb <br /> Contamination No ed - yes/47r— <br /> Storage <br /> ea/Storage Location • <br /> . n. <br /> p <br /> A <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> -� <br /> Distance to sewer line Waited <br /> "Coon " <br /> Domestic well on site - yes ��P <br /> If yes, location & distance - ° . <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size <br /> Quantity Installed Bag" cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />