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MONITORING WELL INSTALLATION REPORT <br /> Date s // / � U <br /> CONSTRUCTION <br /> Premise Addreast 94 <br /> r St Well No. A4 G'- t <br /> Inspectors Total Depth q" <br /> Screen Length Zif _ <br /> Filter Pack SL �,ot 445r <br /> Permit No. Pp <br /> Bentonite Pellets <br /> Consultant •e Grout S( l <br /> Geologist <br /> completion-Stove pipe chriatie box <br /> tin � <br /> Auger O.D. <br /> SAMPLING Auger I.D. <br /> Holding Temperature <br /> Method <br /> .tl.tup <br /> Screening Method <br /> Tracking Sheet (y/n) � <br /> M1OVE•GHOUND <br /> COWLETION Qx.M-box <br /> SPOILS CG"KET"4 <br /> // s.ow s..n.c. <br /> Storage Mgthod.2c� l I.ef4... a <br /> i /. ��r� <br /> Contamination Noted - yes'/no A. <br /> Storage Location �ry, — .n• <br /> 1 <br /> SPECIAL. pERMIT INFO W,Wd = <br /> yn.d patl <br /> Distance to sewer line = <br /> Domestic well on site - yea/no = <br /> If yes, location & distance - --n• <br /> OROUTINO <br /> MATERIALS USED: <br /> Depth to wsater 5� <br /> Mix Ratios Casing type"Jc' <br /> Blank ')a ft. Screen f i <br /> Inetallatlgn Method ne ,�- ft. <br /> QuantityI Slot Size '07- <br /> Bags g@tailed t�s_ Bags cement <br /> Buckets bentonite <br /> ' <br /> Bags sand <br /> 3.. Filter <br /> /gravel <br /> Pack type/size <br />