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*E S OF <br /> MONITORING WELL INSTALLATION REPORT <br /> 3 /-71 <br /> Date: 'I-/— �O CONSTRUCTION <br /> Premise Address: <br /> V/J Well No. l(_j <br /> Inspector• Total Depth 1615) Sj MiI4r <br /> Screen Lengthaa--so W-�-9> l5-)W <br /> Filter Pack <br /> cc Bentonite Pellets <br /> Permit No. /U s-/ Z Grout /3 - 1/ <br /> Consultant -so ,4ec A Completion-Stove pipe/christie box <br /> Geologist �—'7 _ <br /> Auger O.D.1'6" <br /> Auger I.D. <br /> SAMPLING <br /> --7-- G/3 rl <br /> S'M u/Q i �nST ✓ 7 <br /> Holding Temperature stldaup <br /> Method <br /> Screening Method <br /> ABOVEGROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) OUMPLETbN COMPLETION <br /> Circurd Surface <br /> SPOILS grout <br /> Storage Method <br /> Contamination Noted - yes .o n, <br /> Storage Location n, <br /> 7 <br /> m <br /> SPECIAL PERMIT INFO, p <br /> dotted 8 <br /> Distance to sewer line— sscIlon <br /> Domestic well on site - yes g� pravelpadt <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size dG <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />