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,AGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: to A A V CONSTRUCTION <br /> Premise Address: �rU/V Well No. /1 � <br /> Inspector: Total Depth <br /> Screen Length <br /> Filter Pack "(o$ --'1 "!J'i <br /> Bentonite Pellets —'9 <br /> Permit No. 7 n o 22,e'57 Grout --! 2 <br /> Consultant 14 , S. Tuts Completion-Stove pipe Christie b <br /> Geologist Z)13043 Dheldvt <br /> Auger O.D. ��• � <br /> Auger I.D. <br /> SAMPLING ------- -- ---- <br /> �j"'b stick-up <br /> Holding Temperature <br /> Method C.a+r <br /> Screening Method wtiq <br /> ZC <br /> .. <br /> AE&E-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> //�� grout <br /> Storage Method /d11.W"S <br /> Contamination Noted no � <br /> Storage Location <br /> 61 <br /> b <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> slotted <br /> Distance to sewer line section <br /> Domestic well on site - yes — grav-01p <br /> ack <br /> If yes, location & distance - <br /> ..it. ft. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water W Casing t pe c QQ �G ( q <br /> Mix Ratios Blank ft. Screen' ft. <br /> Installation Method Slot size d,c7/fj <br /> Quantity Installed Bags cement <br /> Buckets bentonite 2 <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />