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MONITORING WELL INSTALLATION REPORT <br /> Date: ! � L� <br /> CONSTRUCTIONj� <br /> Premise Address:// J�G Well No. !` <br /> Inspector K�<-.CG�/AC5/ Total Depth_ ry� <br /> Screen Length 17_1' -/_7_71__ <br /> Filter Pack <br /> Permit No. <br /> U Bentonite Pellets <br /> Grout <br /> Consultant ,3 Completion Sto` e pi a Christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. df�r <br /> SAMPLING 6 <br /> cA, - 5 <br /> Holding Temperatu stick-up <br /> Method <br /> Screening M)athod <br /> ABOVE GROUND <br /> Tracking heet (y/n) COMPLETION CHRISTY•BOX <br /> COMPLETION <br /> SPOILS - Ground Su1xo <br /> Storage Method grout <br /> Contamination ted - yes/nott. <br /> Storage Loca on <br /> n. <br /> = d <br /> a <br /> SPECIAL PERMIT INFO. —_ <br /> n <br /> Distance to sewer line slottrrd = B <br /> Domestic well on site - yes/no wcdon _ <br /> If eslocation & stance - OnVWDaa <br /> fC,GROUTING <br /> MATERIALS USED: /L <br /> Depth to water Casing type l u`-/� 5*- I,� S / <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 />