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r € <br /> ,E <br /> MONITORING WELL INSTJLLLATION REPORT <br /> �r <br /> Date: / �C� $I.CONSTRUCTION <br /> Premise Address: ell No. <br /> Inspector• Total DepthY~ <br /> I Screen Length <br /> fFilter Pack <br /> q �q tBentonite Pellets <br /> Permit No. ! t( 7! Z rout _? - <br /> Consultant C'�w.h. �1Completion-Stove pipe/ ristie o <br /> Geologist W <br /> t uger O.D. B-Z <br /> Auger I.D._ �i�. c3o `9 <br /> SAMPLING <br /> Holding Temperature 4/ C. ***.Up <br /> Method e c?v <br /> 71 Screening Method O f�M _. <br /> Tracking Sheet r- n) ' (7OMPLETiDN-GROIIPfC} CHRISTY-SOX <br /> COMPLETION <br /> Ground Surface <br /> SPOILS #- <br /> /� 91001 <br /> Storage Method �,-4A G <br /> Contamination Noted - yes/ o �ft• <br /> Storage Location C,2 ft. <br /> - b <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> dottod .: — c <br /> Distance to sewer_line 7 S ; "ctlon <br /> Domestic well on site - yes/( i' <br /> 7"park <br /> If yes, location & distance - { <br /> GROUTING <br /> MATERIALS USED: <br /> Depth towaterf Casing type T/C SC�4',c) <br /> Mix Ratios <br /> Blank--,< £t. Screen / Sr ft. <br /> Installation Method Slot size ©- 02 0 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> r Bags s ?n /gravel 2Filt� ck type/size s- <br /> x <br />