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�..r I-q0,GE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date• °(� ` / CONSTRUCTION <br /> Premise Addres• �i22 �` Well No. /!'(K/_� <br /> Inspector• Total Depth d <br /> Screen Length <br /> Filter Pack C> <br /> // Bentonite Pellets Z(c�- <br /> Permit No. 7 Grout D- Z(o <br /> Consultant Completion-Stove pipe/christie box <br /> Geologist <br /> Auger 0.D. 10 <br /> Auger I.D. 7 Y <br /> SAMPLING <br /> ? stk*-up <br /> Holding Temperature <br /> Method �.. R�-O`�-� <br /> Screening Method PID _ _ ..-n <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet on) coMPLETION COMPLETION <br /> ll// Ground S ace <br /> SPOILS <br /> Storage Method <br /> Contamination Noted -"yes o ft. <br /> Storage Location ft. <br /> a <br /> SPECIAL PERMIT INFO. <br /> slotted _ I <br /> Distance to sewer line taction <br /> Domestic well on site - yes = pa <br /> If yes, location & distance - <br /> i <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water J! , Casing type `1�i '0%3 C' <br /> Mix Ratios Blank '-50 ft. Screen 2-a ft. <br /> Installation MethSA .fig Slot size D2 <br /> Quantity Installed = D � u Bags cement <br /> Buckets bentonite A. <br /> Bags sand/gravel 67 <br /> Filter Pack type/sizes <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />