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• PAW OF <br /> MONITORING WELL. INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: well No. <br /> Znsnector• Total Depth <br /> Screen Length <br /> Filter Pack <br /> Bentonita Pellets <br /> Permit No. Grout <br /> Consultant Completion-Stove pipe/christie box - <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> . _ stictc-up <br /> Folding Temperature <br /> Met:^od � <br /> • <br /> Screening Method •- <br /> AgOVE-,GRCUND CNRISTY-BOX <br /> Tracking Sheet (v/n) <br /> Cot1PLc!ON ccmpLETION <br /> C7wrd Surface <br /> S?OILS "1A <br /> Storage Method _L.---ft <br /> Contamination Noted - yes/no ft. <br /> Storace Location <br /> a <br /> — m <br /> _ o <br /> 5?ECIAL PERbiZ IT INFO- '- o <br /> doted =_ c <br /> Distance to sewer line <br /> Domestic well on site - yes/no = 7+yelPack <br /> IP yes, location & distance - <br /> i <br /> ft. _ft. <br /> GROUTING <br /> MAmERIALS USED: <br /> Casing type <br /> F';Dept:^ to water �.. <br /> Blank `t. .Screen <br /> }Mix Ratios <br /> Slot size <br /> )Installation Method - <br /> �Quantity Installed <br /> Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> it-ter Pack type/size <br /> Trtal Billed Time Per Site <br /> Date Permit Finalized <br /> 1 <br />