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F ,E OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: G/ r S �� CONSTRUCTION <br /> Premise Address: f///!/• f���'�`� Well No. <br /> Inspector: Total Depth SO <br /> �+ Screen Length 6-0--30 <br /> s Filter Pack o-a <br /> Bentonite Pellets _.9 d _ <br /> Permit No. Grout <br /> Consultant Completion-Stove pi Christie box <br /> Geologist i�0-- <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temper t re t <br /> C t ` stldc-up <br /> Method <br /> Screening Method .. <br /> ABOVE-GROUND CHRISiY-BOX <br /> Tracking Sheet (y COMPLETSON COMPLETION <br /> Ground Surface <br /> SPOILS <br /> grout <br /> i <br /> Storage Method <br /> Contamination Noted - es no ft' <br /> Storage Location n' <br /> e <br /> m <br /> SPECIAL PERMIT INFO. = e <br /> slotted 'E <br /> Distance to sewer line upon = <br /> Domestic well on site - yes <br /> gmvw Pack <br /> If yes, location & distance - "• <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water / Casing type Wk2-1— <br /> Mix <br /> Ratios Blank ft. Screen ft. <br /> Installation Method Slot size , 0 Z__ <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized ���,�,,•� /�� <br />