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MONITORING WELL INSTALLATION REPORT <br /> Date: %� % �,' CONSTRUCTION <br /> Premise Address:--�---< . Well No. _3"/TC- A.Pddti <br /> InspectorTotal Depth e P / Y,1 <br /> J 1 <br /> Screen Length <br /> Filter Pack `. ,..� '. <br /> Bentonite Pellets <br /> Permit No. ll-i'nc.'i Grout --- <br /> Consul <br /> Geologtant_ (r- Completion-Stove pipe/ghristie box <br /> Geologist �'�_ <br /> Auger O.D./J <br /> SAMPLING Auger I.D./ ' <br /> ` <br /> Holding Temperature Zt . a�-up <br /> Method .7 <br /> Screening Method A,� ^ - V <br /> ABOVE-GROUNDTracking Sheet (y/n) COMCOOMPLETION CMPLPLETITIOEN <br /> ON <br /> SPOILS <br /> Ormond Sudan <br /> �y grout <br /> Storage Method N i�>>�7__. •1'�+ <br /> Contamination Note - yes noJn. <br /> Storage Location m., -:.ac65ri n. <br /> SPECIAL PERMIT INFO. _ z <br /> 1 <br /> Distance to sewer abdad <br /> line l ! aacuon <br /> Domestic well on site - yearffi4 �� = �� <br /> If yes, location & distance� Z8 - _ <br /> z9•f = <br /> pack <br /> 3�•" � n. `` = n. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water-� Casing type p[ f- <br /> Mix Ratios CP1-- 1 Blanlc L2L i L,'ft. Screen 17- ft. <br /> Installation MethodtxiPi Slot size _0�— <br /> Quantity Installed /tl,-+ ' Bags cement <br /> Buckets bentonite I, '\— <br /> Bags sand/gravel cc.--.- , P <br /> Filter Pack type/size "/ <br />