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MONITORING WELL INSTALLATION REPORT <br /> Date: /C `i Cr'/r <br /> CONSTRUCTION <br /> Premise Address: v- T /�2ti�� �1 C U� <br /> Well No. <br /> Inspector:. f;.._h-@ C ( Total Depth ,6'._ <br /> Screen Length � <br /> Filter Pack . <br /> Permit No. j� _ f Bentonite Pellets - <br /> Grout <br /> Consultant Completion-Stove pipe/christie bax ' <br /> Geologist <br /> Auger 0.D. - <br /> SAMPLINGAuger I.D. <br /> Holding Temperature l' 6f slk*'uP y <br /> Method :I_1_3__ <br /> Screening Method._ i� <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet r��n) COMPLETION COMPLETION <br /> SPOILS Ground Surface <br /> n _ ZZ9roui <br /> Storage Method ��1 � 3 <br /> Contamination 40ted - ye/no n• <br /> Storage Location r i- ��. ft. <br /> m <br /> A <br /> SPECIAL PERMIT INFO. <br /> C <br /> O <br /> — <br /> Distance to sewer line s <br /> L lotwd <br /> sectiolctlon <br /> Domestic well on site - yes/no = �vW P <br /> If yes, location & distance - <br /> ack <br /> Z ( ft. 2- <br /> GROUTING GROUTING <br /> MATERIALS USED: <br /> Depth to watert C' Casing type � 1 f 1. L= <br /> Mix Ratios Blank ft. Screen `_ ft. <br /> Installation Method i �.c ���E w Slot size -L,- ' C' <br /> Quantity Installed _�'�✓�-�" r Bags cement L' - ✓ <br /> Buckets bentonite / �- <br /> Bags sand/gravel <br /> Filter Pack type/size -.711-1- <br />