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f <br /> MONITORING WELL INSTALLATION REPORT <br /> Date$ <br /> Za Z2� CONSTRUCTION <br /> Premise Address: r� well <br /> Inspectors Total Depth O <br /> Screen Length <br /> Filter Pack <br /> L/ <br /> r Bentonite Pellets / <br /> Permit No, Grout <br /> Geologist <br /> Consultant !�: completion-Stove pipe/ ristie x <br /> Auger O.D. p" <br /> � I.INl3 Auger I.D. <br /> Holding TemperaturI <br /> Method '/L 4"t f a�cee <br /> Screening Method / stk*-up <br /> Tracking Sheet y/ ) <br /> ABOVE Gr1otlNa <br /> COMPLETION GiriiSTf(+OX <br /> SPOILSCO MPLMDN <br /> Storage Method t44" IP04 <br /> Contamination Noted - yesno / -u-L�n• <br /> Storage Location p <br /> aro�ud <br /> S CI E IT I FO. <br /> Distance to sewer lins_l�L�- <br /> Domestic well on site - yes/no <br /> If yes, 10PAtion & distance <br /> QR <br /> OUTIN[i ' • <br /> 08—""" MATERIALS USED: <br /> Depth to water � Casing type ?t/C/ <br /> Hix Ratios <br /> InetallatiBlank Z O ft. Screnep Method ft• <br /> Slat Giza <br /> Quantity Ioaitalled = Bags cement /�LQGS <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/sizes <br />