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• PAC_OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: II Well No. L/'u <br /> Inspector: 1•y60 tKin Total Depth a�a <br /> Screen Length /o <br /> Fiiter Pack 1,C 2-./I Ck S1 -d o 'rG)j <br /> c <br /> Bentonite Pellets 11AA-- <br /> Pe^.nit No. Grout r4l +o fA <br /> Consultant - Completion-Stove pipe/christie box .. <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. -I <br /> SAMPLING <br /> Holding Temperature <br /> Method YT <br /> Screening Me od _ <br /> Ag©yE GACUND CNRIM-BOX <br /> Tracking reset (y/n) pNqL--TCN CCMPL-'TION <br /> - Cxwnd Surface -T-�—^ <br /> SPOILS ro <br /> grout <br /> ' Storage Method <br /> Cortaminat;on Noted - yes/no <br /> fl. <br /> Storace L cation �D <br /> O <br /> SPECIAL PERMIT INFO. ot = o. <br /> ' slotted � c <br /> Distance to sewer lire - action <br /> Domestic well on site - ves/no = g <br /> I." ves, location & distance <br /> = i <br /> . . � tt = �d ft i • <br /> GROUTING ... . . <br /> MATERIALS USED: n <br /> Depth to water IZ �2/ Casing type fyc <br /> Mix Ratios Blank. (J a. Screen 1 <br /> rt <br /> Installation Method Slot size 0110 a0 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel S <br /> Filter Pack tvpe/size <br /> :)tal Billed Time Per Site <br /> its Permit Finalized <br />