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MONITORING WELL INSTALLATION REPORT <br /> Date: U CONSTRUCTION <br /> Premise Address: Well No. <br /> Inspector:. r=�i <br /> _ ;, L �'or��'%rd Total Depth IQ 7 q <br /> ZEX CP � �S f. Screen Length �7 <br /> /l�✓ /�/$/�c{i�.� Filter Pack Jr a� i SCi2'p�l-J.. �Yc Au1f4 <br /> Bentonite Pellets /5' " clal_7rt s ' <br /> Permit No. Grout ��Ol!✓��LMr�7�/7 <br /> Consultant S Completion-Stove pipe/christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature <br /> Method17' <br /> ua.,p <br /> Screening Method <br /> 7WWT <br /> Tracking Sheet (y/n) AbOVE{,NDNND <br /> LOMWLEf10N CNNiSIYMP <br /> TIDN <br /> CD �ETIDN <br /> SPOILS OnAmw S <br /> piety <br /> Storage Method i<f.5.0 <br /> n. <br /> Contamination Noted - yes/no <br /> Storage Location <br /> 0 <br /> .a�Na s <br /> SPECIAL PERMIT INFO. ••OY1^ —_ <br /> a.,rp. <br /> Distance to sewer line = <br /> Domestic well on site - yes/no / n <br /> If yes, location & distance - <br /> GROUTING MATERIALS USED: � �jJ `/� <br /> Depth to water Casing type s-o-' u� Trla� " • G <br /> Mix Ratios -? eleVel ?7 Blank ft. Screenft. <br /> Installation Method T Yly�/Av_ Slot size /'l, 0/6 <br /> Quantity Installed Bags cement <br /> Buckets bentonite eaY <br /> Bags sand/gravel A <br /> Filter Pack type/size 3 11t4A <br />