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WAGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: I 10 CONSTRUCTION f <br /> Premise Address: zoo well No. <br /> Inspector, Total Depth 2 <br /> �j. S �45Screen Length 2 -'• " <br /> Filter Pack -SZ <br /> dd Bentonite Pellets -(.p -4 <br /> Permit No. Grout -4---> O' <br /> Consultant Completion-Stove pipe/christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. rr.25" <br /> SAMPLING - — — -- — <br /> Holding Temperature 40 Sm*-up <br /> Method dar- <br /> Screening Method 0VM <br /> ABOVE-GROUND CHRIS"TY-BOX <br /> Tracking Sheet (y/n) GOMPLErION COMPLETION <br /> G=nd Surface <br /> SPOILS <br /> grout <br /> Storage Met hod -+2S?IG_ <br /> Contamination Noted -�00no <br /> Storage Location ft' <br /> m <br /> p <br /> v <br /> SPECIAL PERMIT INFO. <br /> n <br /> c <br /> Distance to sewer line mon <br /> Domestic well on site no <br /> 9MV81 P&* <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water—14—o W OrrLsg, - Casing type'ge-a 40 W(- (2P� <br /> Mix Ratios Blank 7 ft. Screen ft. <br /> Installation Method Slot size 0-DID <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel_ S <br /> Filter Pack type/size__ fti� 1�2L3 <br /> Total Billed 'Time Per Site <br /> Date Permit Finalized CLs?Z k�2 l�lA t3lls� <br />