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MONITORING WELL INSTALLATION REPORT <br /> Date: 'J CONSTRUCTION <br /> Pr Ae Add re <br /> AddsWell No. w ' <br /> Inspector: Total Depth <br /> Screen Length <br /> Filter Pack <br /> n �,(2 Bentonite Pellets <br /> Permit No. Y d �l Y J_ Grout <br /> Consultant (£C.. Completion-Stove pipe/christie box <br /> Geologist 41aylllo 11-)jw& $f2191� <br /> Auger O.D. <br /> Auger I.D. Z <br /> SAMPLING <br /> Holding Temperature <br /> Method <br /> �Udc„p <br /> Screening Method <br /> CA— <br /> Tracking Sheet y/ A80VE-GROUNO ` <br /> COMPLEnON COOMPLETION CMKEMN <br /> SPOILS arm"Sree <br /> p�wt <br /> Storage Method <br /> Contamination Noted yes no <br /> Storage Location h. — <br /> — n <br /> sloc4id _ <br /> SPECIAL PERMIT INFO. ��cvon <br /> _ prirrlpadc <br /> Distance to sewer line <br /> Domestic well on site - yes00 <br /> If yes, location & distance - n• — n. <br /> GROUTING MATERIALS USED: � <br /> Depth to water �.4 Casing type, Su 4-0A 6 <br /> Mix Ratios ILtI Blank--Jtg�L ft. Screen 30 _ft. <br /> Installation Method Slot size 0. 0/0 <br /> Quantity I;►stalled Bags cement_ L <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size_ Z <br />