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MONITORING WELL INSTALLATION REPORT <br /> Date: I/2-Z/`�/ <br /> r/U CONSTRUCTION <br /> Premise Add eae: Well No. <br /> Z <br /> Inspector .(� Total Depths _ <br /> Screen Length_l <br /> Filter Pack. <br /> c� _ObYn� Bentonite Pell te�,¢A <br /> Permit No. Grout ' <br /> Consultant _ Completion-Stove pipe Christie box <br /> Geologist <br /> Auger O.D. /U <br /> SAMPLING <br /> Auger I.D.— <br /> Holding Temperature OL stIcki+P <br /> Method Zd&4- 'r P <br /> Screening Method — <br /> 3 7 f <br /> ABOVEGROUND CHRISTY-BOX <br /> Tracking Sheet /n) COI.PLETION <br /> COMPLETION <br /> SPOILS <br /> Oraurd SuAaa <br /> proal <br /> Storage Method <br /> Contamination Noted - yemzwft. <br /> storage Location 6k—ode �'R Z� 7 ' fl. <br /> n. <br /> _ <br /> SPECIAL PERMIT INFO. — <br /> dOlud E <br /> Distance to sewer line //IA— secYlun <br /> Domestic well on site - yes . __ <br /> If yes, location & distance - ' gravel pack <br /> Z. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing t e y��P✓L <br /> Mix Ratios_ !'O.r�+-�- Blank_ ft. Screen �S ft. <br /> Installation Method --- 71-----C'------ Slot size -- b ti <br /> Quantity Installed _ Bags cement <br /> l Buckets bentonite /A- <br /> Bags sand/gravel /Z <br /> Filter Pack type/size <br />