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MONITORING WELL INSTALLATION REPORT <br /> Date:-L/ C_ ��� CONSTRUCTION <br /> Premise Address:_ F e"I Well No. <br /> Inspect Total Depth b <br /> y Screen LengthS� O <br /> Filter Pack <br /> Bentonite Pellets G'- <br /> Permit No. ��—✓ U/ Grout -57'- <br /> Consultant Completion-Stove pi c ristie box <br /> Geologist `", 4 /fes/�✓�s" --- <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> atldtup <br /> Holding Tempera ore <br /> Method <br /> - Tf�T_ <br /> Screening Method <br /> ABOVE-GROUND CHRIMY•BO% <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> Otound Surf <br /> SPOILS <br /> proof <br /> Storage Meth <br /> Contamination Noted - yee/no <br /> n. <br /> Storage Locati n n <br /> p <br /> m <br /> SPECIAL PERMIT INFO. c <br /> o <br /> slatted -- <br /> Distance to scer line vection <br /> Domestic well o site - yes/no = gravel pack <br /> If yes, location :6 distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water 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 />