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ZV <br /> PAGE__L0F__�j_4 <br /> ..AA--....�� MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: n� 'Lt Well No. <br /> Inspector: Total Depth <br /> Screen Length_ <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. _s .2 Grout <br /> Consultant Completion-Stove pi a/christie box <br /> Geologist <br /> er O.D. <br /> Auge .D. t <br /> SAMPLIN{i <br /> l.0 fie. G�, tldc <br /> Holding Temperature '. <br /> Method <br /> Screening Me hod 1 <br /> A$OYE-GRCXJNQ CHRISTY-BOX <br /> Tracking Sheet Qy ) COMPLETION j <br /> COMPLETION <br /> Ground S ace <br /> SPOILS { <br /> /j grout t <br /> Storage Method <br /> Contamination Noted-/ ye no i <br /> ti. <br /> Storage Location <br /> SPECIAL PERMIT INFO. <br /> slotted ` <br /> Distance to sewer line !"V "cion <br /> Domestic well on site - ye -o = graA <br /> ack <br /> I£ yes, location & distance <br /> GROUTING j <br /> MATERIALS USED: <br /> Depth to water 7-Y Casing type a <br /> Mix Ratios Blankft. Screen ft. <br /> Installation Method . Slot size d <br /> Quantity Installed f Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed"'Time Per Site . <br /> j <br /> Date Permit Finalized <br /> 1 <br />