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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise 'Address;f6 s�/l/-ci �-- Well No. /'/C✓ ,"' �� <br /> Inspector:_ Total Depth_ to/r . 2- <br /> screen <br /> screen Length 35 <br /> Filter Pac36' <br /> —� <br /> Permit No. <br /> Z Bentonite Pellets 756- - 33,--- � trout :3 3— �_ I <br /> consultant M,.j 4 Completion-Stovei <br /> Geologist 'st ie bo <br /> /✓/is/I c✓ <br /> P <br /> Auger O.D. <br /> SAMPLIAuger I.D. <br /> NG A <br /> Holding Temperature <br /> Method_ <br /> S i - �aa/J � ackap <br /> Screening Method___0!,L,4-7 <br /> Tracking Sheet ( __ <br /> ,��-- AbOVEdNWND <br /> GOMw�tlIDN CObox <br /> MMS " <br /> -SPOILS � � i <br /> �� am"Surl.c�. <br /> Storage Method lir <br /> w� <br /> contamination Noted - ye o �c__n• <br /> �h h. <br /> Storage Loc tion <br /> 0 <br /> SPECIAL PERMIT INFO. WWII = V <br /> 2U <br /> w•.�paY <br /> Distance to sewer line = <br /> Domestic well on site - 'yes/no <br /> If yes, location & distance - <br /> GROUTING MATERIALS USED: <br /> Depth to water s S Casing type_ <br /> Mix Ratios Blank ft. Screen 3o ft. <br /> Installation Method Slot size �J 2 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />