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MONITORING WELL INSTALLATION REPORT <br /> Date: ///7/1/ CONSTRUCTION <br /> Premise Address:/,427 • h Well No. /W o) Z <br /> Inspector:, .r.P Total Depth <br /> Screen Length 73 " <br /> Filter Packs #-03 _ <br /> Bentonite Pellets S 5 ✓ <br /> Permit No. Grouter <br /> Consultant eRM l Completio -Stove pi.p ychristie box <br /> Geologist_ S- -4-� / <br /> Auger O.D. <br /> Auger I.D.6 h <br /> SAMPLING <br /> Holding Temperature l ` stk*'up <br /> Method <br /> T <br /> Screening Method"/ t)I Sic R I✓ .. T <br /> ABOVE-GROUND CHRISlY-BOX <br /> Tracking Sheet((y7i) COMPLETION COMPLETION <br /> Surlwe <br /> SPOILS ��� _+ <br /> pr0ut <br /> Storage Method <br /> Contamination Noted - yea/�►o/ n• <br /> n. <br /> Storage Locationfi,--✓.><�z.. (/,� n. <br /> _ m <br /> a <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> "1�` sloriad <br /> Distance to sewer line esaon <br /> Domestic well on site - yestho <br /> qmve!pack <br /> If yes, location & distance`- <br /> =n. — -70 n. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to waterI�S Casing type �� Z <br /> Mix Ratios ' Blank ft. Screen .2-cb ft. <br /> Installation Method tom• - Slot size .0/0 <br /> Quantity Installed Bags cement <br /> Buckets bentonite S <br /> Bags sand/gravel <br /> Filter Pack type/size <br />