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MONITORING WELL, INSTALLATION REPORT <br /> Date: �(,fir z �� <br /> CONSTRUCTION <br /> Premise Address 0 ct � Well No. <br /> es <br /> Inspector: Total Depth 62 <br /> Screen Length ' <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. _ Grout <br /> Consultant Completion-Stove pipe/ isti box <br /> Geologist <br /> Auger O.D. <br /> Auger T.D. <br /> SAMPLING <br /> Holding Temperature etk*-up <br /> Method <br /> _21-�-���� —qw-f <br /> Screening Method 7,F6 <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y ) COMPLETION COMPLETION <br /> SPOILS G=nd Surface <br /> b / Qraut <br /> Storage Method <br /> Contamination Noted - yes no • <br /> Storage Locatio -• " (�ti n• <br /> ti. <br /> w <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line <br /> Domestic well on site <br /> gravel pa* <br /> If yes, location & dist a -k` <br /> b�Tt. it. <br /> GROUTING <br /> MATERIALS USED: <br /> f g t'V( 21' -_ <br /> Depth to water �� Casin <br /> Mix Ratios Blank_ fScreen42 ft. <br /> Installation Method Slot size <br /> Quantity Installed 4-1 ? Bags cement <br /> Buckets bentonite_ <br /> Bags sand/grave l <br /> Filter Pack type/size__- Al <br />