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i <br /> MONITORING WELL INSTALLATION REPORT <br /> `i <br /> it <br /> I <br /> IL <br /> Date:4 � I b <br /> CONSTRUCTION <br /> Premise Address: Well Na. f'3 <br /> Inspector: No. <br /> Total Depth <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. Grout f <br /> Consultant Completion-Stove pi christie ox <br /> Geologist '"k.. <br /> Auger O.D. <br /> Auger I.D. `/ I <br /> SAMPLING <br /> Holding Temperature �. a�-up <br /> Method lvi4 <br /> r.�s c.0 <br /> Screening Method <br /> ABOVE-GROUND <br /> Tracking Sheet (y/ ? OOMPLETION CHRISTY-BOX <br /> COMPLETION <br /> SPOILS GMUnd Urfwe <br /> 3 <br /> V pttwt <br /> Storage Metho p <br /> Contamination Noted - es �P) <br /> Storage Location-,12L-, l i1, <br /> ...4-1. <br /> m <br /> I ia <br /> SPECIAL PERMIT INFO. — • {( <br /> P A <br /> sl°Sa <br /> DistaGnce to sewer line ,�Qn $ <br /> Domestic well on site - yes 7 <br /> If yes, location & distance - `� !` 1mvWpax* <br /> GROUTING ' <br /> MATERIALS USED: i <br /> Depth' to water f Casing type <br /> Mix Ratios 7 Blank__6 ft. Screen ft. <br /> Installation MethodSlot size . 6 24> <br /> Quantity Installed Z_. - Bags cement �.�S <br /> Buckets bentonite <br /> Bags sand/gravel F _ <br /> i 2 <br /> i Filter Pack type/size 6 S 5A,-,e/ i <br /> 1 <br /> 17 � I <br />