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PAO OF <br />MONITORING WELL INSTALLATION REPORT <br />Date: <br />CONSTRUCTION <br />Premise Address: <br />Well No. <br />Inspector: <br />Total Depth <br />Screen Length <br />Filter Pack <br />Bentonite Pellets <br />Permit No. <br />Grout <br />Consultant <br />Com_ietion-Stove pipe/christie box <br />Geologist <br />Auger O.D. <br />Auger I.D. <br />SAMPLING <br />Bolding Temperature <br />Met,^.od <br />Screen-; nc Method <br />Tracking Sheet (v; n) <br />SPOILS <br />Storage Method <br />Contamination Noted - yes/no <br />Storage Location <br />SPECT -II, PERMIT INFO. <br />Distance to sewer lire <br />Domestic well on site - ves/no <br />1.4 ves, location & distance - <br />GROUTING <br />Dect" to water <br />Mix Ratios <br />Installation Method <br />uanti-•✓ I, stalled <br />'otal Billed Time per Site <br />ate Per_ri +- ! Jna14 zed <br />stic}c-up <br />ABCVE-GRC(JND C.� {Ri5TY-30X <br />CtiP, 'L.�'i'aN CCMPi...=TICN <br />C.-vind Surface <br />grout <br />ft. <br />ft. <br />ft. <br />p <br />_ m <br />c. <br />o <br />slotted = c <br />Sn� pack <br />i <br />ft. <br />Jt. <br />_ i <br />MATERIALS USED: <br />Casing type <br />Blank -4t. Screen :.t. <br />Slot size <br />Sacs cement <br />Buckets.bentonite <br />Bags sand/gravel <br />Filter Pack type/siz <br />