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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> r <br /> Premise Address: ���� � f�`- Well No. <br /> /\/' <br /> Inspector: Total Depth 5 <br /> Screen Length /- G _ <br /> Filter Pack <br /> Permit No. Grout Bentonite Pellets <br /> ! % k <br /> Consultant hc,i� � s <br /> Geologist Completion tOVe pipe/chriatie box <br /> L;,, a'u ,�,/;-.., s <br /> Auger O.D. <br /> SAMPLINAuger I.D. <br /> G W <br /> Holding Temperature sUdrup <br /> Method <br /> —TFW-f <br /> Screening Method <br /> Tracking Sheet (y n) ABOVE-GROUND <br /> -BOX . <br /> COMPLETION <br /> COMPLETION <br /> SPOILS � � <br /> proal <br /> Storage Meth <br /> o L <br /> Contamination oted - yes/no ♦ }(, <br /> Storage Locatio ft <br /> h. <br /> 7a <br /> SPECIAL PERMIT INFO <br /> _ e <br /> Distance to sewer line IL sIollyd = <br /> Domestic well on site - yea/no Nction = g <br /> If yea, location & distance - DmvWpack <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water �� �� <br /> 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 />