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MONITORING WELL INSTALLATION REPORT <br /> is . <br /> Date: CONSTRUCTION <br /> i <br /> Premise Address: Well No. <br /> Inspect ' Total Depth <br /> Screen Length <br /> -201 <br /> Filter Pack <br /> �O(„�'`� Bentonite Pellets <br /> Permit No. ��JJ Grout <br /> Consultant Completion-Stove pip c ristinbo <br /> Geologist <br /> Auger O.D. <br /> i Auger I.D. <br /> SAMPLING _. <br /> Holding Temperature adck-up <br /> Method ' <br /> Screening Metho T <br /> ABOVE-GROUND BOX <br /> IS7Y- <br /> Tracking Sh t (y/n} COMPLETION CCHRHRISLY- OX <br /> SPOILS i . Ground&+Mace <br /> Storage Method �c7 <br /> Contamination Noted - yela/no tt• <br /> Storage Location 2 - <br /> n. <br /> SPECIAL PERMIT INFO. <br /> S � C <br /> ited <br /> C � �l <br /> Distance to sewer line <br /> --Zht� �on <br /> Domestic well on site - y s nvW <br /> -= <br /> If yes, location & distance il gmP <br /> ack <br /> Ln. n. <br /> GROUTING <br /> MATERIALS USED- <br /> Depth to water € casing type <br /> Mix Ratios Blank• ft. Screen _ft. <br /> Installation Method ; Slot size 4 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size-V� 7 <br />