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MONITORING WELL INSTALLATION REPORT <br /> Date: / CONSTRUCTION <br /> Premise 'Address: � Well No. /'l �✓ 7 <br /> Inspector• f' Total Depth S <br /> Screen Length_ <br /> Filter Pack 2_57 - 8- <br /> Bentonite <br /> Bentonite Pellets <br /> Permit No. d' Grout �p <br /> Consultanticv �6 �5 Completion-Stove pipe <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature <br /> Method <br /> .udkwp <br /> Screening Method <br /> Tracking Sheet (y/n) \� <br /> ABOVE-GROUND <br /> COMPLETION CMRISTY-WX <br /> COMPLETION <br /> SPOILS �-Graud suns. <br /> piaA <br /> Storage Method <br /> Contamination Noted - yes/no <br /> Storage Location n. — <br /> b <br /> — r <br /> — C <br /> P <br /> SPECIAL PERMIT INFO. ,�cyon = I <br /> — Orrrd pads <br /> Distance to sewer line = <br /> Domestic well on site - yes/no <br /> If yes, location & distance - <br /> GROUTING MATERIALS USED: <br /> Depth to water Casing type <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 />