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• &E -q OF <br /> MONITORING WELL INSTALLATION REPORT <br /> S 4ea,, GXf+cc �rrr1''n LaeAJsl <br /> Date: 13 /1 CONSTRUCTION�v1S ne./ ,tnJecf'�c9✓t y,�"k <br /> Premise Address: 'O' r'9 Well No. /'i L✓ ?== <br /> Inspector:_ C= Total Depth SO <br /> Screen Length ell- 3.;? ' 1I-SJ��^^k <br /> Filter Pack <br /> O Bentonite Pellets 00 <br /> Permit No. /U 5� Z Grout ate- ✓ <br /> Consultant r_--7oo ifG Completion-Stove pipe chris 'e box <br /> Geologist l �� ✓ <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> etickup <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> ABOVEGROUND cHRISTY-BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> 6rWnd Surface <br /> SPOILS proal <br /> Storage Method <br /> Contamination Noted - yes/no h, <br /> Storage Location <br /> 0 <br /> SPECIAL PERMIT INFO. <br /> slotted $` <br /> Distance to sewer line salon <br /> Domestic well on site - yes/7q'� = gravel pack <br /> If yes, location & distancel/- <br /> GROUTING <br /> MATERIALS USED: <br /> •f �PV�i <br /> Depth to water �-s Casing type <br /> Mix Ratios7r�,s,�di3 Rra/�r�d f c�MBlank ft. Screen S ft. <br /> Installation Method _3 'A, �e-i16 - Slot size / <br /> Quantity Installed Bags cement �o✓� ��✓I T_ J� <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />