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• WE / OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: / �7/i U II�I CONSTRUCTION <br /> Premise Address: 7X I K h Well No. M (-A 13 I-.1 (�j .� <br /> Inspector Total Depth .?3 S <br /> � Screen Length ZZ- 7 ' -3S <br /> Filter Pack .2-3- -5- 9'5- 31 <br /> Bentonite PelletsS-7•S None <br /> Permit No. U- 3 2�3 Grout <br /> Consultant L Completion-Stove pipe ristis box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING - <br /> Holding Temperature stidt-up <br /> Method <br /> Screening Method T <br /> ABOVEGROUND CHRISTY-BO% <br /> Tracking Sheet (y/n) OOMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> 1 proal <br /> Storage Method 6�54'c <br /> Contamination Noted - yes/ �ft. <br /> Storage Location ft fl. <br /> mn L e- <br /> dti <br /> m <br /> m <br /> SPECIAL PERMIT INFO. $' _ c <br /> 0 <br /> Slotted <br /> = $ <br /> Distance to sewer line section = <br /> Domestic well on site - yesno <br /> pack <br /> If yes, location & distance - <br /> _ ft. <br /> GROUTING <br /> MATERIALS USED: <br /> y <br /> Depth to waterCasing type e f'/ <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size 10-2— <br /> Quantity <br /> OZQuantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size ' <br /> Total Billed Time Per Site a <br /> Date Permit Finalized���- /� <br />