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s , <br /> F l <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: I �U <br /> CONSTRUCTION <br /> Premise Addrea : f ,2�Er <br /> Well N - <br /> Inspectar• .�-� Total Depth <br /> ` <br /> Screen Length 561 <br /> Filter Pack S&-,X <br /> Bentonite Pellets <br /> Permit No.— `� Grout <br /> Consultant _ Completion-Stove pipe/chriatie box <br /> Geologist <br /> Auger O.D. It) "' <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature atk*-up <br /> Method /e <br /> Screening Method f ( 7/4_ <br /> Tracking Sheet A80�-GROUND CHRISTY-BOX <br /> g ) COMPLhT$ON <br /> COMPLETION <br /> SPOILS GmKwod Swfam <br /> Storage Method . ll��{i✓ WosA <br /> I� <br /> Contamination Noted - yes no ft. <br /> Storage Location 1Lc <br /> ft. <br /> 0 <br /> SPECIAL PERMIT INFO. _ • <br /> Distance to sewer line&�� dottad <br /> Domestic well on site sooOn _ <br /> - yes/no <br /> If yes, location & distance - = IV "NPa(* <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to waterb <br /> Casing type 1b(')1/__1 19 <br /> Mix Ratios a. CAU-a_ Blank, ft. Screen 3O ft. <br /> Installation Method Slot aize <br /> Quantity Installed Bags cement <br /> Buckets bentonite r C4 <br /> Bags sand/gravel 64-<-44� <br /> Filter Pack type/size # <br />