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t <br /> I <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: Al n_ 3 fl $'2 CONSTRUCTION <br /> Premise Address: I Y SOC) well No. � <br /> Inspector• L Total Depth <br /> Screen Length X-7 r a -Z <br /> Filter Pack F - 'i6 <br /> Bentonite Pellets -1'e 761 - / <br /> Permit No. IZ9 Z T12 Grout F <br /> m •-/ <br /> Consultant Completion-Stove pip Christie bo <br /> Geologist .�_ C A4AIZ& l <br /> Auger O.D. 7.3 <br /> Auger I.D. 3, 3- <br /> SAMPLING SAMPLING <br /> Holding Temperature Ll <br /> Method <br /> Screening Method - <br /> Tracking Sheet on) ABOVE-GROMD <br /> coMPLVION 01RIM-box <br /> COMPLET" <br /> SPOILS ^^'-Oro"S <br /> " Wa4 <br /> Storage Method <br /> Contamination Noted - yes/no n• <br /> Storage Location 14/FAD a n' : _ <br /> S• Ali <br /> w • <br /> SPECIAL PERMIT INFO. 'Kaon <br /> sr = 9MVW pads <br /> / T . <br /> Distance to sewer line w <br /> Domestic well on site - yes/ o <br /> If yes, location & distance - n• n• <br /> GROUTING MATERIALS USED: <br /> Depth to water Casing type Pd L 5011- Yd <br /> Mix Ratios Q 5. ,.E' Blank ?( ft. Screen '�aO ft. <br /> Installation Method Fes- !bo// Slot size 0 . r'] r,�,,,• <br /> Quantity Installed t Z S Y& Bags cement _.. <br /> Buckets bentonite / <br /> Bags sand/gravel <br /> Filter Pack type/size-f` 3' OA VS <br /> 3 <br />