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• &E OF <br /> MONITORING WELL INSTALLATION REPORT <br /> (O Ma)pj, Irl�S G„oe.l15 <br /> Date: �-3 /� CONSTRUCTION <br /> Premise Address: T� Well No. 3 C <br /> Inspector: Total Depth aS <br /> Screen Length a0�/S �S-Z�-��c✓1 /c <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. 'g� Grout <br /> Consultant .45D Y � Completion-Stove pip Christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. VIJ <br /> SAMPLING <br /> sUdcuP <br /> Holding Temperature <br /> Method T <br /> 7.31 <br /> T <br /> Screening Method <br /> ABOVE-GROUND CHRISTY-Box <br /> Tracking Sheet (y/n) COMIPLETION COMPLETION <br /> �,���Ground Surface <br /> SPOILS <br /> grout <br /> storage Method <br /> Contamination Noted - yes/no n, <br /> Storage Location n, _ <br /> �• m <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> dotted = 8 <br /> Distance to sewer line teo6on <br /> Domestic well on site - yes/no = pravelpack <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: n <br /> Depth to water Casing type Py <br /> Mix Ratios Blank ft. Screen S ft. <br /> Installation Method slot size G <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site L-) 1 -5 <br /> Date Permit Finalized eK"c �-7on (re ��$ <br />