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MONITORING WELL INSTALLATION REPORT <br /> Date: 7/9/ CONSTRUCTION <br /> Premise Address: Well No. w <br /> Inspector: < Total Depth <br /> Screen Length 1 <br /> Filter Pack U <br /> Bentonite Pellets 6efi <br /> Permit No. Grout Ag �: <br /> consultant Completion-Stove Pi e/ • ristie—bxGeologist ` <br /> Auger O.D. O ` <br /> Auger I.D. <br /> SAMPLING _.._ <br /> Holding Temperature /'JA edck++P <br /> Method Iff I <br /> —EWTScreening Method � <br /> ABOVE-GROUND <br /> Tracking Sheet (y/n) CHRISTY•BO% <br /> _1AA COMPLETION COMPLETION <br /> SPOILS � � 7 — <br /> grot4 <br /> Storage Method - node G8 <br /> Contamination Noted - yes n. <br /> Storage Location <br /> �v n. <br /> = e <br /> SPECIAL PERMIT INFO. = s <br /> do6d E <br /> Distance to sewer line utdon <br /> Domestic well on site - yes6i; <br /> If yes, location & distance - ; gnivel pack <br /> k'. <br /> GROUTING <br /> MATERIALS USED: <br /> 7 <br /> � ��L b <br /> Depth to water -�_ casing type ' <br /> Mix Ratios 1- Blank ft. Screen <br /> Installation Method Slot size -0-2- <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel S L <br /> Filter Pack type/size 7 <br />