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PAG_ OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: [ �7 Gly CONSTRUCTION <br /> Premise Address: S ` Well No. SO,..,DCy, <br /> Inscector:J411 Total DeA'-1 <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellet, <br /> Permit No. Grout <br /> Consultant Completion-Stove pipe/christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> -- � I <br /> Folding Temcerature sbck-up <br /> Method Ir <br /> Screening Method _� W <br /> ABOVE-GACLJND IIE <br /> CNAISTY-BOX <br /> Tracking Sheet (y/n) C^MfP��T,aN <br /> COMPLETION <br /> CY�.:nd SL-e -9 <br /> SPOILS <br /> flrcxA <br /> Storage Method ft. <br /> Contamination Noted - _res/no ft. <br /> Storace Location ft. <br /> SPECIAL PERMIT INFO. — c. <br /> slotted = c <br /> Distance to sewer lire tac�on <br /> Domestic well on site - yes/no �nyW pack— <br /> If ves, location & distance - <br /> ft. — ft• <br /> GROUTING 7P 2� <br /> ''!!,, MATERIALS USED: <br /> C� ` <br /> Depth to nater casing type <br /> Mi:< Ratios Blank ft. Screen ft. <br /> '.nstallation Method Slot size <br /> Quantit•r _Installed Sacs cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack tvge/size <br /> 'otal Billed Time Per Site <br /> ,,ate P er n t Finalized <br />