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GE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: l" t CONSTRUCTION <br /> N . v� <br /> Premise Addre s• Well No. <br /> ITotal Depth <br /> Inspector: <br /> Screen Length - 3c) <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. 110 Grout <br /> Consultant Completion-Stove pi christie box <br /> Geologist -� <br /> Auger O.D. 1� <br /> Auger I.D. <br /> SAMPLING <br /> . I <br /> atfdt-up <br /> Holding Temperature <br /> Method T <br /> Screening Me hod Ply <br /> ASOvE-GROUND cHRisnr-sox <br /> Tracking Sheet ) ODM?LErION COMPLETiO <br /> Ground St�ace <br /> SPOILS grout <br /> Storage Method `i ft• <br /> Contamination Noted - e no ft. <br /> Storage Location46 <br /> W <br /> m <br /> SPECIAL PERMIT INFO. o <br /> slotted ` <br /> Distance to sewer line section <br /> Domestic well on site -- yes/9) gra park <br /> if yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: ��II <br /> Depth to water W Casing type „ r v C <br /> Mix Ratios Blank_ ft. Screen L 5 ft. <br /> Installation Method tA7 _� - Slot size O 2 <br /> Quantity Installed Bags cement <br /> Buckets bentonite 1 <br /> Bags sand/gravel U.S <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />