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MONITORING WELL INSTALLATION REPORT <br /> Date:�, 9 O CONSTRUCTION <br /> Preml Address: Well No. PIC' <br /> Sh lam• <br /> Inspec�tpor: Total Depth <br /> ..(2 , �• Screen Length In <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No, g 9 �' �/�� Grout / : <br /> Consultant Completion-Stove pi a/christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature <br /> Method ��y�I'IfI'p^fl�l1''/jTr� <br /> •'A Fj •tick�p <br /> Screening Method <br /> Tracking Sheet (y/n) AeovE•GRGunG _ff WT <br /> COMPLUbN Crwlsn.aox <br /> COMPLETION <br /> SPOILS Ground Sulac• <br /> piM <br /> Storage Method <br /> Contamination Noted - yes/no r n. <br /> Storage Location lin• —_ <br /> _ o <br /> ,laud = 3 <br /> SPECIAL PERMIT INFO. •action — <br /> aw•l pack <br /> Distance to sewer line = <br /> Domesticwell on site - yes/no -_ <br /> If yes, location & distance - —n• �n. <br /> GROUTING MATERIALS USED: <br /> Depth to water_ 13 Casing type o /` S�-•f.{' <br /> Mix Ratios q AAd'k I Blank ft. Screen ft. <br /> Installation Method Pu»i� Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />