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AGE I OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date .0 ` CONSTRUCTION <br /> Premise Add C7 ALP Well No. P _ <br /> Total Depth <br /> Inspector: r <br /> Screen Lengtr <br /> Filter Pack <br /> Bentonite Pellets / <br /> Permit No. a- Grout <br /> Consultant 104 Completion-Stove pip /christie ox <br /> -- <br /> Auger O.D. /0 <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature L U S**-Up <br /> Method �f L:�� �.� <br /> Screening Method 1 <br /> A80NF--GROUND CHRiSTY-BOX <br /> Tracking Sheet COMPLETION COMPLETION <br /> Ground Surlcww <br /> SPOILS <br /> grout <br /> Storage Methodf <br /> Contamination Noted - yes no <br /> n. <br /> Storage Location A t <br /> CD <br /> P— <br /> CD <br /> = o <br /> SPECIAL PERMIT INFO. n <br /> s/ 0jW <br /> Distance to sewer line bt-4 vection <br /> Domestic well on site - yes/no = gMyWP <br /> If yes, location & distance -- _ <br /> Qn• tt. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water !�� r Casing type � <br /> r <br /> Mix Ratios �I.1 erg c..-� � Blanks_ ft. Screen ft. <br /> Installation Method Slot size <br /> Quantity Installed �� -- Bags cement 6 S <br /> Buckets bentonite /A-4 <br /> 1- <br /> Bags sand/gravel <br /> Filter Pack type/size__, <br /> C <br /> Total Billed Time Per Site -e—' <br /> Date Permit Finalized <br />