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3 _ <br /> �GE J OF <br /> q . <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: ` �U CONSTRUCTION <br /> Premise Add"res •�YG� Clay, <br /> No. r✓l r <br /> Inspector• Total Depth 310' <br /> Screen Length <br /> Filter Pack /J& Z <br /> Bentonite Pellet <br /> Permit No. 6'�� Grout /oOnw.z,All IA <br /> Consultant T Completion-Stove pipe/chr.istie box <br /> Geologist LM- <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING -- <br /> t t,� atidtup <br /> Holding Tpe <br /> / rature 7 <br /> Method S j/_A4 [✓ <br /> Screening Method P/6 •. <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (q/n) COMPLUION COMPLETION <br /> Ground Surlace <br /> SPOILS <br /> grout <br /> AQ <br /> Storage Method �� n <br /> Contamination Noted - yes n y n <br /> n. <br /> Storage Location Q� -Iiz� <br /> SPECIAL PERMIT INFO. = o <br /> slotted = � <br /> Distance to' sewer line zg,/ section <br /> Domestic well on site - yengravel pack <br /> if yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water LU Casing type <br /> Mix Ratios r. Blank_ ft. Screen /S� ft. <br /> Installation Method Xe Slot size <br /> Quantity Installed Bags cement 7 Malt <br /> Buckets bentonite 7_11S <br /> Bags sand/grave l <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized - <br />