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• W-E OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: �l9 D CONSTRVCTION <br /> Premise Address: yyd Well No. �W <br /> InspectoTotal Depth 9�, S1 <br /> r:_ c/ <br /> Screen Length $cf. S- <br /> T s Filter Pack 9Q - G/• S <br /> Bentonite Pellets <br /> Permit No. <br /> 3 z GroutS •S - <br /> Consultant Complet n-Stove pipe hristiebox <br /> Geologist /2- eP <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> atldaup <br /> Holding Temperature <br /> Method, Tftl <br /> Screening Method <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) cof"PLETION COMPLETION <br /> ,..,��.Ground Surface <br /> SPOILS <br /> QfWt <br /> Storage Methodf , ft. <br /> Contamination Noted - yes <br /> Storage Location O � <br /> m <br /> e <br /> SPECIAL PERMIT INFO. 0 <br /> slotted B <br /> Distance to sewer line / section <br /> Domestic well on site - yes = gravelpadt <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type <br /> Mix Ratios Blank ft. Screen ZS ft. <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size � <br /> Total Billed Time Per Site 1\ <br /> Date Permit Finalized L <br />