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PAGF OF <br /> j <br /> MONITORING WELL INSTALLATION REPORT <br /> • I <br /> i <br /> Date: l CONSTRUCTION <br /> Premise Address: ILA l well No. <br /> Ins_oector Total Depth <br /> Screen Length <br /> P <br /> filter ack <br /> Bentonite Pellets S A- <br /> per-mit- No. Grout <br /> Consultant OC, Completion-Stove pipe/christie box <br /> Geologist <br /> - Auger O.D. <br /> G ��r Auger T_,D. <br /> �stldc j <br /> Holding Temperature , up <br /> Met;o <br /> Screening Method .r <br /> ABCVE-GACUND AIS7Y 80X <br /> TrcCVP!LE <br /> Tracking Sheet {v/n) � CGviP1.=-TICK <br /> Ground Surixa ®® - <br /> SPOILS i _ T <br /> grout <br /> Storage Method ft. <br /> Contamination Noted - yes/no <br /> Storage Location 5Oftj <br /> _ m <br /> I <br /> SPECIAL PER-MIT INFO. = c. <br /> o � <br /> slotted — c <br /> Distance to sewer lire sec�on = <br /> Dcmestic well on site - ves/no <br /> grivel pack <br /> IZ yes, location & distance <br /> i <br /> 64 <br /> GROUTING <br /> K TERIALS USED: <br /> Dent : to water Casing type <br /> Mix Ratios Blank ft. .Screen ft. <br /> _^stallatiori Method Slot size <br /> Quantit,r Installed Bacs cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> ___ter Pack type/size <br /> Total Billed Time Per Site <br /> r t <br /> Dag--• _°er Finalized <br />