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PAGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date:_(r�Tf S•' CONSTRUCTION <br /> Premise Address: LQSM t1w'.,.n,."' Well No. M44) �. <br /> Inscector: J�AAAAIC.- Total Depth L�s <br /> Screen Length L f <br /> Filter Pact: <br /> Bentonite Pellets � • � <br /> Permit No. SR5 (20 }Z.Z.c{,f Grout qV <br /> Consultant Aja '�zz.yn Comoietion-Stove pipe c ristie bo- <br /> Geologist <br /> Auger O.D. �K,• <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature <br /> ` aticft-up I <br /> Method <br /> Scraeni ng . nod <br /> A90YR-GRCUND CHPIM-Box <br /> Tracki Sheet (_v/n) C�ONVLEj'ON CCMPL-TION <br /> SPOILS <br /> Arm <br /> Storage Method V` N <br /> Contamination ted - yes/no Z•S fl. <br /> Storage Lo ion <br /> _ a <br /> = m <br /> SP EC T_AL PERMIT INFO. — <br /> C <br /> _ O <br /> SlO ned _ C <br /> Distance t0 Se r line = $ I <br /> Domestic w on site_ - yes/no <br /> If ves, ocation & distance <br /> = i <br /> n. n. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to wzter Casing type L VL' <br /> Mi:< Ratios 3 1 a n k °t. Screen - <br /> Instzllation Method ,btny��(• Slot size .`O1 D <br /> Qua nt° ty Installed y /;cp a... /f�5 Sacs cement % (e <br /> 'II ' Buckets be r.t unite <br /> 3ags sand/g=avel <br /> ?-;Iter Pack tyDe size 1 <br /> it(-aotal Billed Time Per Sit(- <br /> -ate <br /> te Permit. Finalized <br />