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• • I&GE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date• L`�yC� CONSTRUCTION <br /> Premise Address: z""k Well No. y6 ` 3 <br /> In agtor: Total Depth L/6 r <br /> Screen Length � -3 <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. Grout_ I u' ; o _S✓--flLtC-e <br /> Consultant Completion-Stove pipe Christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. 3 3/y <br /> SAMPLING --- --- <br /> Holding Temperature eUck-up <br /> Method <br /> Screening Method ._ <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) COMPLETION <br /> COMPLETION <br /> Ground Surface <br /> SPOILS <br /> grout <br /> Storage Method <br /> Contamination Noted - yes/no ft' <br /> Storage Location ft' <br /> m <br /> SPECIAL PERMIT INFO. '- <br /> '" o <br /> slotted = E <br /> Distance to sewer line vection _ <br /> Domestic well on site - yes/no _ gravW P <br /> ack <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water 3 / Casing type MixRatiosRatios Blank 3S ft. Screen !y ft. <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />