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MONITORING WELL INSTALLATION REPORT <br /> .5 <br /> I0 A <br /> Date• �7_ 3 01 P i' CONSTRUCTION . <br /> Premise Address:_//$ Ott € „ Well No. <br /> Inspector•__ <br /> Total Depth - scg <br /> E; Screen Length F-A? -3 ra .1� _ <br /> Filter Pack FM - 3l TT V <br /> Bentonite Pellets - /�Z ra' <br /> Permit No. 49- Z g 7 3 I' Grout <br /> Consultant t'Z�`rq ! Completion-Stove pipe hristie box <br /> Geologist•_ <br /> Auger O.D.-- e�r' <br /> Auger I.D. 4 <br /> SAMPLING <br /> Holding Temperature I/ i C. <br /> Method <br /> 6"-Up <br /> Screening Method <br /> TrackingSheet �eovE iROUND <br /> n <br /> ;�. COMPLETION CMRISTY•BO7f <br /> COMPLETION <br /> SPOILS arx,rd SuRac� <br /> Storage Method 0-) S. 71- ! Drool <br /> Contamination Noted - yes/� <br /> Storage Location cro-o — <br /> 'V = m <br /> � w <br /> SPECIAL PERMIT INFO. a.aion v _ <br /> f� �YYI pack <br /> Distance to sewer line > /00 r <br /> Domestic well on site - yes no J — <br /> If yes, location & distance - n• - h. <br /> i� <br /> tl <br /> iE <br /> GROUTING MATERIALS USED: <br /> , Depth to water z n E Casing type <br /> Mix Ratios Blank ft. Screen Z e) ft. <br /> Installation Method / Slot size - <br /> Quantity Installed Bags cement__ Q <br /> Buckets bentonite j <br /> Bags sand/gravel ' <br /> Filter Pack type/size 1-4,4"4S1W/� � <br /> !E I <br /> � gypp' <br />