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• OPAGE__LOF <br /> ONITORING WELL INSTALLATION REPORT L <br /> C 1'6 <br /> Date:(' ci �" CONSTRUCTION <br /> Premise Address: U�GIi� Well No. �✓ �� G�� <br /> Inspector / -e,6 Total Depth_ <br /> l Screen Length .s&6.5� (�7• S- .S <br /> Filter Pack 87- 6Y I /68 - ' <br /> entonite Pelletstw'6 - y <br /> Permit No. rout <br /> Consultant i Completion-Stove pi / hrystie bo <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> stick-up <br /> Holding Temperature ap- <br /> Method <br /> L <br /> Screening Method O� <br /> ABOVEGROUND I C 4RISTY-BOX <br /> Tracking Sheet (y/n) COWPLETION COMPLETION <br /> SPOILS <br /> Orourd Sumacs 7— <br /> proal <br /> Storage Method k ft. <br /> Contamination Noted - yes/no n, <br /> Storage Location g, <br /> = e <br /> SPECIAL PERMIT INFO. _ o <br /> slotted <br /> Distance to sewer line section <br /> Domestic well on site - yes/no = prawlpadc <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 Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> _ Filter Pack type/size <br /> Total Billed Time Per Sitea,? 72/ ,Sd <br /> Date Permit Finalized <br />