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PAGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: 4 'I� 4� CONSTRUCTION <br /> Premise Address: /403 0&41J-J?N Ct tt,6 Well No. M(c) s <br /> Inspector: Total Depth <br /> 5o"-' Screen Length -4 > -24 <br /> Filter Pack 45> -/ 9 <br /> Bentonite Pellets —/S —/7 <br /> Permit No. V - 072K Grout -/7 -&- <br /> Consultant '[I CO/L'o �omp1etion-St0ve. pipe c ris ie box P-,M4 <br /> Geologist 01gi./ bj I Nhl <br /> Auger O.D. 121/4- <br /> Auger I.D. a V4 <br /> SAMPLING <br /> Holding Temperature ftk-up <br /> Method <br /> Screening Method <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> Ground Surface <br /> SPOSurface <br /> grout <br /> Storage Method b4t'MS ft, <br /> Contamination Noted - yes/no el <br /> n. <br /> Storage Location <br /> SPECIAL PERMIT INFO. o <br /> WoUd -- <br /> Distance to sewer line <br /> auction x' <br /> Domestic well on site - yes grawlPack <br /> If yes, location & distance - .— <br /> -4'4 <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water 31 Casing type 4� PJC- <br /> Mix Ratios �/ v�/�LK n/� _ Blank 24 ft. Screen ZO ft. <br /> Installation Method 771--1 J& Slot size 0•CO2-0 <br /> Quantity Installed 70 C4►4�5 Bags cement -I <br /> Buckets bentonite 2 1s <br /> Bags sand/gravel <br /> Filter Pack type/size -*�- 212 <br /> Total Billed Time Per Site \ <br /> Date Permit Finalized CQ�(&� Z 1 <br /> �� ,�� M W- 5 <br />