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-GE -I OF 'f <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: /���L0 CONSTRUCTION <br /> Premise Adds -r D Ot r�- ` Well No. Mal 7 <br /> Inspector: Total Depth 1301 <br /> Screen Length .SJ, <br /> Filter Pack Z&h' <br /> Bentonite Pellets 2-7fT <br /> Permit No. 70'`7,-7 Grout C.Bf- 11� <br /> Consultant Z. T Completion-Stove pi ch�stie box <br /> Geologist <br /> Auger O.D. /Q <br /> Auger I.D. (, '/z/' <br /> SAMPLING -- <br /> Holding Temperature 7 stick-up <br /> Method <br /> Screening Method PT-6 al T <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet 6YA <br /> ) COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> gout <br /> Storage Method -1�ft.Contamination Noted ye n <br /> Storage Location lJ( .eft. <br /> V <br /> _ m <br /> SPECIAL PERMIT INFO. _ c <br /> G� slotted <br /> Distance to sewer line section _ <br /> Domestic well on site - yes _ gravai <br /> If yes, location & distance - <br /> ft. <br /> GROUTING <br /> MATERIALS USED: <br /> / <br /> Depth to water Z61 Casing /�G L(H <br /> ty e <br /> Mix Ratios C Blank ft. Screen /� ft. <br /> Installation Method Slot size ,D <br /> Quantity Installed Bags cement 144 <br /> Buckets bentonite Z z- I <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />