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v -.II'AGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: i � CONSTRUCTION <br /> Premise Address: ����� <br /> Well No. <br /> Inspector: 4<,,, ti —� Total Depth <br /> Screen Length <br /> Filter Pack2+ - <br /> ;� ' ! Bentonite Pellets i in <br /> Permit No. Grout <br /> Consultant ��' Completion-Stove pipeJchrlstie x <br /> Geologist r - <br /> Auger O.D./- <br /> Auger I.D. <br /> SAMPLING —Y--- - - - <br /> Holding Temperature afJdaup <br /> Method <br /> V3M 021— <br /> Screening Method ,.c.� <br /> ABOVEGROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> ���.Ground Swfwe <br /> SPOILS <br /> grout <br /> Storage Method ) 6' <br /> Contamin Noted yea <br /> Storage Location n, - n' <br /> tt. <br /> _ <br /> — o <br /> SPECIAL PERMIT INFO. = c <br /> — o <br /> Wotud <br /> Distance to sewer line L�i��7�_ Notion <br /> Domestic well on site - ye <br /> If yea, location & distance - <br /> grave!pack <br /> ft. <br /> f - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water �� / Casing type <br /> Mix Ratios Blank-1.2 ft. Screen ft. <br /> Installation Method ^�� Slot size L -?-- <br /> Quantity Installed Bags cement <br /> Buckets bentonite ' <br /> Bags sand/gravel=-'N - /z- <br /> Filter Pack type/size 7 <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />