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'AGF OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: 2 - nr- ! CONSTRUCTION <br /> Premise Address: /.3r1 s CC1TlWell No. <br /> Inspector: Total Depth hewn <br /> Screen Length —(oo f — <br /> Filter Pack '0-30 <br /> Bentonite Pellets- ©- > —2A <br /> Permit No.— 91- 0139 Grout -Z 1 .46' <br /> Consultant G 1-11r Completion-Stove= pipe/ hristie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature <br /> 4, atk*-up <br /> Method 6M /CA <br /> Screening Meth ._ <br /> ABOVE-GROUND <br /> Tracking Sheet n) COMPLETION CHMPLETIO <br /> On) <br /> COMPLETION <br /> SPOILS Ground Surface _• <br /> pr♦o�� <br /> Storage Method CO 6 `/ �b" s <br /> Contamination Noted - es no n• <br /> Storage Location <br /> ft. <br /> = o <br /> SPECIAL PERMIT INFO. <br /> l o <br /> Distance to sewer line section <br /> Domestic well on site - yesGP pack <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing ty e At <br /> G <br /> Mix Ratios Blank ft. Screen 2, ft. <br /> Installation Method h�'1 L� Slot size 0. 0240 <br /> Quantity Installed Bags cement q3/iG/,LQ <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size 2 2. <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />