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,.,AGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: ' CONSTRUCTIO,Nr <br /> Premise Address: U60 Iy . WtC-,yy1 toft'.l J Well No. <br /> Inspector: Total Depth 45 <br /> S' s Screen Length ^4$�­jP -�2T_ <br /> Filter Pack "-w " <br /> Bentonite Pellets <br /> '� Y• <br /> Permit No. CJD — Z Y� Grout -/i,'q- - <br /> Consultant_ • 'f^l . _ Completion-Stove pipe chr�stie box <br /> Geologist DIAAV bIVM- •Z S <br /> Auger O.D.— <br /> Auger I.D. Z <br /> SAMPLING — <br /> ,� stick-up <br /> Holding Temperature <br /> Method /du �. <br /> Screening Method ... <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet &n) COMPLETON rouCOMPLETION <br /> Gnd Surface �-----�"' <br /> SPOILS <br /> proof <br /> Storage Method_ b4mjlm <br /> Contamination Noted - s o ft <br /> Storage Location <br /> — a <br /> m <br /> SPECIAL PERMIT INFO. o <br /> slotted -` <br /> Distance to sewer line vection — <br /> Domestic well on site - yes gravel pack <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: ( �,,`` Q� ( ` <br /> Depth to water Casing ty J � `'fes � - <br /> Mix Ratios Blank ft. Screen 2V <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size 3 <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />