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- 1 <br /> OF- / <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: �G/ CONSTRUCTION <br /> Premise Addres :.W�Zs T Well No. Ilr <br /> Inspector: Total Depth <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. Grout , <br /> Consultant Ll— Completion-Stove pipe/christie box j <br /> Geologist � <br /> Auger O.D. !� <br /> Auger <br /> SAMPLING _,._.._. <br /> I <br /> Bolding Temperature 'C t✓ slldt-up <br /> Method 13A_4_.a A..' <br /> Screening Method <br /> AE&E4ROUND CHRISTY-BOX <br /> Tracking Sheety ) .COMPLETION COMPLETION <br /> Ground Surface T <br /> SPOILS + i <br /> Storage Method <br /> Contamination Noted - ,/noft. <br /> Storage Location ©rti ft <br /> a <br /> m ' <br /> SPECIAL PERMIT INFO. <br /> dotted G ' <br /> Distance to sewer line S� secdon <br /> Domestic well on site - ye no park <br /> If yes, location & distanc <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Z Casing type <br /> Mix Ratios Blank ft. Screen 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 />