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MONITORING WELL INSTALLATION REPORT <br /> Date:_2'22 7 Lq iCONSTRUCTION <br /> Premise Addr s : "v-e, ,� 41_(. well. No. � Z ��t• �d1�--� <br /> Inspector Total Depth�.� _ <br /> Screen Length L)' <br /> Filter PacksOA-P. y <br /> Bentonite Pellets__%,.- <br /> Permit No. /- V/,?, Grout r+� gwi.M. <br /> Consultant Completion-Stove pipe/c risti , ox <br /> Geologist <br /> Auger O.D. <br /> Auger <br /> SAMPLING <br /> Holding Temperature L 8**-up <br /> Method <br /> Screening Method T <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y n) COMPLETION COMPLETION <br /> SPOILS Ground Su'Isce <br /> proof <br /> Storage Method 3 <br /> Contamination Noted - yes%no • <br /> Storage Location <br /> = e <br /> SPECIAL PERMIT INFO. _ <br /> G <br /> 0 <br /> Distance to sewer line Wood $ <br /> "cion <br /> Domestic well on site - yes/no <br /> If yes, location & distance - graH°IPa(* <br /> GROUTING <br /> MATERIALS USED: <br /> r I <br /> Depth to water - Casing ype_ U(� <br /> Mix Ratios,4,lu Lbswr Blank ft. screen _ft. <br /> Installation Method 1 Slot size .OZ-V <br /> Quantity Installed 3 u�'✓� Bags cement <br /> Buckets bentonite %s K4 a-_ <br /> Bags sand/gravel <br /> Filter Pack type/size <br />