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• #__E OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: �!O�• / CONSTRUCTION <br /> Premise Addre s: • `S 1i.a-C� ! (, Well No. /`(�y _ T <br /> Inspector• y-- Total Depth <br /> Screen Length Z — 7 <br /> Filter Pack 2 3 <br /> Bentonite Pellets AAME 10 — y� <br /> Grout <br /> Permit No. <br /> • . S f A Completion-Stove pipe/ <br /> Consultant hri ie box- <br /> Geologist <br /> X11sao9P 353 Auger O.D. <br /> "7 Auger I.D. <br /> SAMPLING <br /> y uoC. ttldc up <br /> Holding Temperature r <br /> Method 'ot <br /> Screening Method m •- <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet y/ ) <br /> COMPLETION COMPLETION <br /> Ground Surfacer--� <br /> Ti <br /> SPOILS l grout <br /> Storage Method ✓ tt• <br /> Contamination Note •yews/no ft. <br /> Storage Location <br /> _ 0 <br /> SPECIAL PERMIT INFO. o <br /> slotted ` <br /> Distance to sewer line / sedan <br /> Domestic well on site - yes no _ gravel pack <br /> If yes, location & distance - <br /> 7ft• = tt. <br /> GROUTING <br /> MATERIALS USED: <br /> Ul_/r Casing type 2 ' eV s� r <br /> Depth to water ft. screen 2-5 Mix Ratios Blank_ <br /> Installation Method <br /> Slot size . 02- <br /> Quantity Installed JlBags cement <br /> Buckets bentonite <br /> ')Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />