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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION �- <br /> Premise Address: MAO N4 LJiMf JWel l No. <br /> Inspector: Total Depth Z. <br /> S. SCGh1JlS7J�cS?f� Screen Length _ F <br /> Filter Pack -A;2' �'��• s <br /> riBentonite Pellets -50.5 � -47,S <br /> Permit No. % 2M Grout <br /> consultant U. 5, TeX, Completion-Stove pi chris ie box <br /> Geologist �f <br /> Auger O.D. • Z <br /> Auger I.D. 25 <br /> SAMPLING -- -- <br /> Holding Temperature 4" s'Ic`-up <br /> Method IGLr- <br /> Screening Method / <br /> /►BOVE•GRO(JND <br /> Tracking Sheet y n) COMPLETION CMRISTY-BOX <br /> COMPLETION <br /> Ground Surface <br /> SPOILS <br /> ZZ' Z/1" proof <br /> Storage Method e <br /> Contamination Noted - y s no <br /> Storage Location <br /> 0.j St — <br /> m <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> Distance to sewer line 9'50 section <br /> Domestic well on site - yes — qraP <br /> ack <br /> If yes, location & distance - <br /> wft. <br /> ,`• <br /> GROUTING <br /> MATERIALS USED: J <br /> Depth to water !v"9. Zr Casing typef'/�t 40 (C- <br /> Mix Ratios 9 15;AC)e_ l'41i' Blank_ ft. Screen -30 ft. <br /> Installation Method -7724.44;4 11r Slot size 0.D10 <br /> Quantity Installed Bags cement_ <br /> Buckets bentonite Z 5V444e _5 <br /> Bags sand/gravel <br /> Filter Pack type/size / Z._ <br />