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SPE OF <br /> T- <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: / l CONSTRUCTION T <br /> Premise Address: f50irc /'/ Well No. 1 Z� <br /> Inspector: Total Depth 70 ' <br /> Screen Length 70--LCD <br /> Filter Pack (> - / <br /> Bentonite Pellets <br /> Permit NO. / /- ` Grout � � S <br /> Consultant _ Coyy��PPlet��ppn <br /> Geologist f//y/eef7'rQ LC�fy i p�virl��/js <br /> Auger y <br /> SAMPLING <br /> stlNcuP <br /> 1 <br /> Holding Temperature <br /> Method Y <br /> ff I <br /> Vol v7w— <br /> Screening Method <br /> ABOVEGROUND CHRISTYWX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> ��l3rourtd Surlacs <br /> SPOILS <br /> grout <br /> Storage Method <br /> Contamination Noted - yes/no ft. <br /> Storage Location n' <br /> fl. <br /> m <br /> _ • <br /> • <br /> SPECIAL PERMIT INFO. <br /> dotted <br /> Distance to sewer line section — $ <br /> Domestic well on site - yes/no <br /> If yes, location & distance - <br /> I <br /> GROUTING <br /> i <br /> MATERIALS USED: 3 <br /> Depth to water O Casing type we <br /> Mix Ratios Blank ft. Screen SO 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 />