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MONITORING WELL INSTALLATION REPORT <br /> Date: 614 Uo CONSTRUCTION <br /> Pr iseAddress: Well No. <br /> Inspector: Total Depth <br /> "0Screen Length <br /> Filter Pack I ss <br /> rr �1 Bentonite Pellelis <br /> Permit No. 7� - Z 413 Grout -'5' --- <br /> Consultant - $ Completion-Stove pipe Christie b <br /> Geologist // (�SbLj SN�TL-� <br /> Auger O.D. <br /> Auger I.D. & Z� <br /> SAMPLING �p <br /> Holding Temperature ` - c- <br /> Method ws <br /> $dck-up <br /> Screening Method 47 <br /> T <br /> Tracking Sheet ) ABOVE-GROUND CHRIM-wx <br /> COMPLETION COMPLETION <br /> SPOILS Oro"S`nacs <br /> Storage Method <br /> Contamination Noted - yes/no n• <br /> Storage Location <br /> G1lf S�r - d <br /> P <br /> aloud = <br /> SPECIAL PERMIT INFO. $anion <br /> f _ pnv$i Pads <br /> Distance to sewer line 7-0 - <br /> Domestic well on site - yes/�g _ <br /> If yes, location & distance <br /> GROUTING MATERIALS USED: <br /> Depth to water. �o`��o� Casing ty 6C,14. <br /> Mix Ratios I Blank_ ft. Screen 'So ft. <br /> Installation Method Slot size • 0/d -y�- <br /> Quantity Installed Bags cement !�fC .A,& g <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size /� <br />