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?AGE :f <br /> MONITORING WELL INSTALLATION REPORT <br /> Date : l`l ll� " C) CONSTRUCTION <br /> Premise Address : ZC� � I'( ' O Well No . <br /> Inspector : Total Depth <br /> Screen Length 70 " <br /> Filter Pack <br /> _ Bentonite Pellets 5 -i - sU • <br /> Permit No . 2 Grout S 0 - <br /> Consultant G Completion- Stove pipe chxistie box <br /> Geologist f' /✓1(je'1 <br /> Auger O . D . y <br /> Auger I . D . <br /> SAMPLING - - <br /> Holding Temper ture L ( f) stldaup _ <br /> Method } �- 5oeo✓7 <br /> Screening Method TIlkl V <br /> ABOVEGROUND CHRISTY•BOX <br /> Tracking Sheet ( y� COMPLETION COMPLETION <br /> ��� Orourd Surface <br /> SPOILS <br /> i L proof <br /> Storage Method "1 5 <br /> Contamination Noted - ye <br /> Storage Location <br /> SPECIAL PERMIT INFO . _ <br /> / = o <br /> S U slotted <br /> Distance to sewer line sacpptt — <br /> Domestic well on site - yesn <br /> gravel pack <br /> If yes , location & distance - <br /> e. = n. <br /> GROUTING <br /> MATERIALS USED : <br /> / 2� <br /> Depth to water � (� Casing tape <br /> Mix Ratios Blank & � 55 ft . Screen 4_ft . <br /> Installation Method Slot size IC2 2 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand / gravel . 5 4' <br /> Filter Pack type / size ' 7 <br /> Total Billed Time Per Site <br /> Date Permit finalized <br />