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PA4 / OF_L <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: z�10 I ``` �' CONSTRUCTION <br /> Premise Add r s: V �. fA <br /> Inspector: Total Depth <br /> Screen Length <br /> ?ilter Pack <br /> �c <br /> 9Bentonite Pellets <br /> Permit X6Lgs �O j',/ Grout <br /> Consultant Completion-Stove pipe/christie box <br /> Geologist w <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Bolding emnerature <br /> Method �/t/nt.✓ <br /> gA50 -GRCUNED) <br /> Screening Method P=t <br /> �a l <br /> STY-30X <br /> Tracking Sheet /n) CCWI`,CN PL�710N <br /> V Ground Solace <br /> SPOILS I <br /> 7 I� <br /> Storage Method N <br /> Contamination Noted - yes n n• <br /> Storage Location _tt <br /> a - <br /> SPECIAL PERMIT INFO. <br /> a&C sc _ <br /> Distance tb sewer line aadon � <br /> Domestic well on site - ves/no j <br /> I: ves, location & distance - <br /> 72yiW pack <br /> GROUTING <br /> MATERIAL USED: <br /> Deptr. to wat=r v_ 6 S� Casing tvpe <br /> Mix Ratios t/c' �^^•`""'� _ Blank 't. Screen <br /> Installation Method l.- Slot size <br /> Quantit,i Installed ,� Bag cement <br /> Bu kets bentonite <br /> 3 gs sand/gravel <br /> :il-ter Pack type/size <br /> 'otal Billed Time Per Site <br /> ate Permit Finalized <br />