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l PE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: �P O CONSTRUCT' <br /> rr CONSTRUCTION �/� <br /> Premise Address:� ` 11 U IA- Well No. t l L�j <br /> Ins^ector: r( D Total Depth job <br /> Screen Length 15� <br /> Filter Pack ' <br /> Bentonite Pellets <br /> Permit No. <br /> Grout <br /> Consultant w Comnletion-Stove nine/christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Tempe:-ature <br /> aticic uP I <br /> Method <br /> Scram;na Method <br /> -R0VE-GRC;UND <br /> Tracking Sheet. (y/n) ' Cti&,Fi e7.'40N CHRISTY-BOX <br /> CGMPLL•"TION <br /> - Ground Surtxe <br /> SPOILS I <br /> proof <br /> Storage Method <br /> Contamination Noted - yes/no ft. I <br /> Storage Locat'_on ft. <br /> — c <br /> 0 <br /> SPECIAL PER,',[!'- INFO. — m <br /> o <br /> Distance to sewer lire slotted = c <br /> aac:ion � I <br /> Domestic well on site - yes/no _= <br /> If yes, location & distance - = S "�i- i <br /> = i <br /> eft. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to *anter Casing type � <br /> �' ✓L <br /> M_:c Ratios 31ank_Sn Ft Screen_ <br /> `t <br /> .^.stallat on Rethod Slot size <br /> Yuant_ty Installed Sacs cement <br /> Buckets .bentonite <br /> Sacs sand/gravel <br /> _ ter Pack type/size <br /> Tota! Billed Time Per Site <br /> Date Per�?it. Finalized <br />