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fi AGE ^OF <br /> MONITORING WELL INSTALLATION REPORT F <br /> f' <br /> Date: CONSTRUCTION <br /> Premise Address: U2 W Well No. � <br /> IIS � <br /> k Inspector•�h'1 TotallLDepth �-� <br /> Screen Length <br /> Filter Pack 7 <br /> } Bentonite Pellets <br /> i <br /> Permit No. J D Grout;! <br /> Consultant. Completion StoveCh <br /> pipe ristie box <br /> } Geologist L'I /c Ply <br /> Auger.! O.D.'� /0 " <br /> Auger' I.D. <br /> SAMPLING --'�-- ' <br /> i W*-up <br /> t: Holding Temperature <br /> Method L v v— ! <br /> Screening Method OV PC <br /> ' ABOVE-GROUND CHRISiY460X <br /> Tracking Sheet (y/n) N COMPLETION <br /> Ground Surlal <br /> SPOILS ' <br /> '} grout <br /> j Storage Method (p <br /> ;! Contamination Noted - yes/no n• <br /> Storage Location ���• _ ft <br /> Q/E.c-et <br /> 40 <br /> m <br /> SPECIAL PERMIT INFO. c <br /> slo6d c <br /> Distance to sewer line aeon <br /> Domestic well on site - yes/no <br /> pack <br /> If yes, location a distance <br /> A. <br /> GROUTING I' I <br /> + MATERIALS USED: <br /> Ik / i" A <br /> Depth to water 1� Casing type V <br /> Mix Ratios Blank ft. Screen S ft. <br /> Installation Method Slot' size <br /> Quantity Installed Bags cement � <br /> Buckets bentonite <br /> Bags! sand/gravel <br /> #. Filter Pack type/size <br /> #. Total Billed Time Per Site <br /> Date Permit Finalized <br /> . r a <br />