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� u <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: / CONSTRUCTION <br /> Premise Address:/,m r--. ���TTr Well No. /n 4,) <br /> Inspector:k� Total Depth '70 <br /> Screen Length,./- <br /> Filter <br /> engthyFilter Packs 4�-U? <br /> �,`J6 � Bentonite PeXlets 2 /54i <br /> Permit No. Grout n , !.'I <br /> Consultant M ( �5 Completio -Stove pip christie box <br /> Geologist Sa ✓ <br /> Auger O.D. , <br /> Auger I.D.(,' <br /> SAMPLING - - - - ----- <br /> Holdin�Temperature •tidc�p <br /> Method 'I� 1%mrti.�•'z <br /> T <br /> IT7 T <br /> Screening Method i,4 L)ICGr-QL _. T <br /> ABOVE-GROUND CHRISIY-BOX <br /> Tracking Sheet((Y-1-6?) COWPLETION COMPLETION <br /> SPOILS GroundT <br /> grout <br /> Storage Method <br /> Contamination Noted - ye84�0�) <br /> ft. <br /> Storage Location&.--.i1, Jz- <br /> ��' n. <br /> SPECIAL PERMIT INFO. <br /> O <br /> c <br /> Distance to sewer line � mon :' = $ <br /> Domestic well on site - yesno _ gravW P <br /> ack <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water SS Casing t pe <br /> Mix Ratios I Blank (-/ ft. Screen .10 ft. <br /> Installation Method -ems Slot size •OIC <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel �,�• l �� <br /> Filter Pack type/size 7 <br />