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I <br /> MONITORING WELL INSTALLATION REPORT <br /> I <br /> Date: SG CONSTRUCTION <br /> Premise Address: d5 well No. <br /> Inspector* Total Depth <br /> Screen Length <br /> Filter Pack <br /> Pack <br /> /� a Bentonite Pellets <br /> Permit No. 7 - Grout 7��.. " Ste.- cG <br /> Consultant-4­r Completion tove pipe Christie box <br /> Geologist C2/� - <br /> /�4 /�er�Jr G iS Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature <br /> Method <br /> Screening Metho <br /> Tracking Sh et (y/n) ABOVE-GROUND CHAIM-box . <br /> COMPLETION COMPLETION <br /> SPOILS Dmurd S <br /> qaul <br /> Storage Method � fn <br /> Contamination Noted - yes/601-1? n, <br /> Storage Location <br /> Vic. � Irr YS��S <br /> slonad <br /> SPECIAL PERMIT INFO. on - <br /> gnvd pad[ <br /> Distance to sewer line_ :AW <br /> Domestic well on site - yes/no <br /> If yes, location & distance - n• tt. <br /> GROUTING MATERIALS USED: <br /> / Depth to waterCasing type___ �G <br /> Mix Ratios Blank ft. Screen Zv £t. <br /> Installation Method G 5 ` SC Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel 5 <br /> Filter Pack type/size : <br />