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r <br /> ?AGE 2--OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: / CONSTRUCTION <br /> Premise Address: 3 U 3SCJ // Well No. �w 2- <br /> Inspector: Total Depth <br /> Screen Length <br /> Filter Pack / Z Z- <br /> /-� Bentonite Pellets g �1- G <br /> Permit No. C.� SG Grout , <br /> Consultant Completion-Stove pipe(chXistie box <br /> Geologist vS <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING - - - - - - — <br /> Holding Temperatu a stk*-up <br /> Method <br /> Screening Method _. <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet ( /n) COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> grout <br /> Storage Method <br /> Contamination oted - yes/no <br /> Storage Locati n <br /> a <br /> SPECIAL PERMIT INFO. _ <br /> slottad c <br /> Distance to sewer line section "- <br /> Domestic well on site - yes/no = qravW P <br /> ack <br /> If yes, location distance - <br /> ft. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type v <br /> Mix Ratios Blank ft. Screen (] ft. <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Siteleols <br /> Date Permit Finalized <br />