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MONITORING WELL INSTALLATION REPORT <br /> Date: ( CONSTRUCTION <br /> Premise Address: �LI Well No. Nu <br /> Inspector• Total Depth a5 <br /> a� Screen Length_ a$-/12 <br /> Filter Pack_ as- �- <br /> Bentonite Pellets <br /> Permit No. Grout <br /> Consultant Com letion-Stove pip <br /> Geologist e chrietie b, �jJ p <br /> Auger O.D. <br /> SAMPLING <br /> Auger I.D. 'r <br /> Holding Temperatpre /Gr°/ *bck-up <br /> Method_�D/i` 'c„Ltp�n <br /> Screening Method'--�7 <br /> r /y ABOVE-GROUND <br /> Tracking Sheet (y/n) COMPLETION CHRISTY-BOX <br /> COMPLETION <br /> SPOILS � <br /> Storage Method '45-41'e- plain <br /> Contamination Noted -®/non. <br /> Storage Location n. <br /> n. <br /> SPECIAL PERMIT INFO <br /> = n <br /> stance to sewer line W01 <br /> /// �Domestic well on site - yea no gun _ <br /> If yes, location 6 distance - — CnvWpack <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type <br /> �yG <br /> Mix Ratios Blank �O ft. Screen_ <br /> Installation Method ft. <br /> Slot size ••� <br /> Quantity Installed Bags cement <br /> Buckets bentonite ek c <br /> Bags sand/gravel- 99 <br /> Filter Pack type/size3 <br /> 5 �� <br />