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it <br /> a PAGE OF - <br /> . . i <br /> MONITORING WELL INSTALLATION REPORT <br /> Date. 3 o CONSTRUCTION <br /> Premise Address: 6U411J A*CAIPt Well No. <br /> Inspector: Total Depth <br /> Screen Length eg2^ <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. <br /> Grout 1 <br /> Consultant Completion-Stove pike chxistie box <br /> Geologist • i <br /> Aku-4er 0.D. <br /> r <br /> D. <br /> SAMPLING <br /> stido-u <br /> Holding T mperature <br /> Method ULZ ` <br /> Screening Method <br /> AgOVE.GROtJNG CHRISTY.BOX <br /> Tracking Sheet(54n) MPLET ON COMPLETION <br /> around Surface <br />[ SPOILS <br />€ proof <br /> Storage method <br /> Contamination Note ye no <br /> Storage Location _�;SI LQ.. _ n. <br /> p <br /> • <br /> SPECIAL PERMIT INFO. — C <br /> 0 <br /> slotted E <br /> Distance. to sewer line section <br /> Domestic well on site - yes/no9MV49padc <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> I <br /> Depth to water _ Casing type <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size0� 0� — <br /> i <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />