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c � <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Well No. 112. <br /> Inspector; Total Depth 3 <br /> Screen Length <br /> Filter pack (� <br /> Permit No. <br /> Bentonite Pell is <br /> �^ � T Grout <br /> Consultant Lt< � r H completion-Stovei <br /> Geologist L7. c ,/ nu p p /christie box <br /> Auger O.D. /fes <br /> SAMPLING Auger SAMPLINGn <br /> Holding Temperature___I <br /> Method <br /> .aa�wp <br /> Screening Method vt <br /> Tracking Sheet (y/ <br /> "OVE4HOUND <br /> G0WNXT" CHRIM-bolt <br /> SPOILS COMKVION <br /> �.+�fkaird SurlK� F.��r... <br /> Storage Method <br /> w� <br /> Contamination Noted - y s on. <br /> Storage Location <br /> SPECIAL PERMIT INFO. &Wed — <br /> Distance to sewer line <br /> Domestic well on site - yes <br /> If yes, location & distance - n• ..._ n <br /> GROUTING <br /> MATERIALS USED: <br /> � � <br /> Depth to wAter S / <br /> Casing type <br /> Mix Ratios nD Hyl <br /> / <br /> Installati Method �yr,.»,'� Blank Z3 ft. Screen Z ft. <br /> Q,c Slot aize , c Z <br /> Quantity Installed Bags LS �crtn <br /> Buckets bent �t <br /> Bags s C r.+,�h <br /> 9 1 3. 5 3 <br /> Filter Pack type/size <br />