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V <br /> MONITORING WELL INSTALLATION REPORT <br /> Date• R/ I�i��O CONSTRUCTION <br /> Pr mi ,e Ad We� Well No. <br /> Inspector: Total Depth <br /> • � Screen Length -�0 -7 -20 <br /> /� - c' Filter Pack <br /> Permit No. 'L(7 X23 b 4- Bentonite Pelle/ts <br /> Grout -� <br /> Consultant_ CCISI�I�L� Completion-Stove pipe christie bo <br /> Geologist Q) &W f-4- JepS- <br /> Auger O.D. Zp <br /> SAMPLING Auger I.D. fe.2 <br /> O <br /> Holding Temperature e_ <br /> Method_ /C c. <br /> •tl kup <br /> Screening MDethoc} <br /> Tracking Sheet (y/n) /WOVE-GROUND <br /> COMPLETION CNRIMbox <br /> SPOILSccMPLENON <br /> onxlna svI•e• <br /> pIm <br /> Storage Method T!C <br /> Contamination Noted - yes no <br /> Storage Location -_ <br /> DN S <br /> SPECIAL PERMIT INFO WOIua <br /> •.cion — A <br /> Distance to sewer line <br /> Domestic well on site - yes/no - <br /> If yes, location 5 distance <br /> GROUTING MATERIALS USED: <br /> Depth to water S / // / <br /> Casing type .glhF- 402- <br /> Mix Ratios Blank_2, ft. ScreenA0 f t. <br /> Installation Method 11bF Wtfs Slot size <br /> Quantity Installed Bags cement <br /> —16 <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size Z <br />