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Ph OF 7 <br /> MONITORING 'N= INSTALLATION REPORT <br /> Date: JVY? Q G ZD Q S CONSTRUCTION <br /> Premise Address: 3d Q well No. <br /> Inspector: Total Depth 70 <br /> Screen Length 7d- is-,, <br /> Filter Pack /Q1 - 53 ' <br /> Bentonite Pellets 5-3' - S/ <br /> Permit No. oo 6-44 DC Grout 5l ' -Fi <br /> Consultant Qvgn c , EnUi`ronrnvx��;rn�,(gg��Completion-stove pipe/ res ie <br /> Geologist laUrPn Card i nal/" ( '9 Gb) <br /> Auger O.D. <br /> Auger 1.D. ` <br /> S- 1 fa 70ze"ra <br /> at S, t„t"Va -, <br /> Folding Temperature .44 sbck-up <br /> Method <br /> Screening Method PID .- <br /> ABOVE-GROUND CHRISTY-SOX <br /> Tracking Sheet y ) CCW F'14ON CCMPL=-TION I <br /> Grund Surixe <br /> S?OILS T <br /> grout <br /> Storage Method JS p,4 <br /> Contamination Noted - y s/� it <br /> Storace Location U72 S.f-e- <br /> 0 <br /> — m <br /> SPECIAL PERMIT INFO. <br /> _ o <br /> slotted = c <br /> Distance to sewer line sacdon = <br /> Domestic well on site - 0e ./no <br /> gnys'Pack <br /> If yes, location & distance <br /> �✓ 5-a <br /> l r� 111 cn2.,5]2-ffj ; <br /> A-11 L Jell /�bQndem�ne.c% C ®?D_F;, = 70 n. <br /> GROUTING `a� Iq5 I� <br /> /}J.S,Jf42 9 d-11 CG�Q MATERIALS USED: <br /> Depth to water (1$ Casing type 02 -itn <br /> Mix Ratios 4 44-1 hoho. rs���+�b ^'a�S�Q��Blank� ft. screen <br /> Installation Method J Slot size 01,0 <br /> Quantity Installed _ _ framrGPik'g-?- Sags cement -1fC14j44'f r- <br /> Buckets bentonite - �S`d /4nelvS <br /> Bags sand/gravel YLMK <br /> . fi <br /> II lter Pack type/size —� �-f TJW, <br /> ` <br /> 'otal Billed Time Per Site fe bUrS <br /> late Penni-+-- Finalized 6 `�-0�' — <br />