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�•/ `0IAGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date• W 21 I_ CONSTRUCTION �. I <br /> Premise Address: 3555 ( 4--Ymr1 ;z Well No. Yvl(.J S <br /> Inspector: Total Depth_�_�Cj <br /> Screen Length <br /> Filter Pack -/5 <br /> Bentonite Pellets —"7J � <br /> Permit No. Qi 0 —30 8 1p Grout —(o I --+tl 8- <br /> Consultant LZ4CIV ILTJ-+ Completion-Stove pipe christie bo <br /> Geologist .Int(- CZ I <br /> Auger O.D. Z' <br /> Auger I.D. <br /> SAMPLING <br /> u <br /> Holding Temperature atlak-up <br /> Method (2w IS <br /> Screening Method T <br /> OV <br /> T ABOVEGROUND CHRISTI-BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> SGround SuAan <br /> SPOILS -- <br /> ptoul <br /> Storage Method ap4nL o » <br /> Contamination Noted - yes/ cif �--'� <br /> Storage Location n• <br /> -_ tl <br /> SPECIAL PERMIT INFO. <br /> I — c <br /> Distance to sewer line �syon S <br /> Domestic well on site - yes no _ gra,,W pack <br /> If yes, location 6 distance <br /> i <br /> / I n. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water /(0 • 5 Casing typegW 410 (IG (2- <br /> Mix <br /> 2Mix Ratios Blank G1 ft. Screen ft. <br /> Installation Method Slot size 0. 0/0 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size Y Iv <br /> Total Billed 'Time Per Site <br /> Date Permit Finalized <br />