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4 1 <br /> MONITORING WELL INSTALLATION REPORT / d <br /> Date• ` <br /> CONSTRUCTION <br /> Premise Address: J�3SU �4C 6/vcl- Well No. OL) 1 <br /> Inspect r: Total Depth 2 <br /> T91 Screen Length_ / Z Z- <br /> Filter Pack <br /> _ / Bentonite 11 is �l^ <br /> Permit No. (! Grout ^ !!S. C <br /> Consultant c� Completion-Stove pip /christie box <br /> Geologist LnV,` <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature atick'up <br /> Method <br /> —WScreening Metho 7,1 r <br /> ABOVE-GRCdJND CNRISTY-BOX <br /> Tracking Sh et (y/n) COMPLETION COMPLETION <br /> SPOILS ���Surface <br /> proal <br /> Storage Method Zzo <br /> Contaminatio oted - yea/no tt• <br /> Storage Lo tion ft. <br /> it. <br /> a <br /> SPECIAL PERMIT INFO. _ <br /> c <br /> — e <br /> Distance to sewer li slo►Wd — $ <br /> vection — <br /> Domestic well on s' e - yes/no <br /> If yes, location distance - _ �vel P <br /> ack <br /> ?t. <br /> GROUTING <br /> y MATERIALS USED:: <br /> Depth to water__ Casing type PV C' <br /> Mix Ratios Blank ft. Screen'30 ft. <br /> Installation Method Slot size <br /> Quantity Installed Bags cement $S'C /yJfjr <br /> Buckets bentonite <br /> /el�4// AC�/�4 7�(G �Gi/�j��� Bags sand/gravel <br /> p( Filter Pack type/size <br /> V <br />