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• 0E OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> //� CONSTRUCTION X <br /> Premise Address: /sv Well No. / V <br /> Inspector: 4 ` Total Depth <br /> Screen Length <br /> Filter Pack -71� <br /> Bentonite Pellets 76 73.5 <br /> Permit No. Grout -73, S - ;:-- <br /> Consultant <br /> Consultant Completion-Stove pipe/christie box <br /> Geologist _ <br /> Auger O.D. s <br /> Auger <br /> SAMPLING - <br /> Holding Temperature stlek-up <br /> Method IF a <br /> Screening Method <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> ��Orourd Surtsos <br /> SPOILS <br /> grout <br /> Storage Method ✓UY�S <br /> Contamination Noted <br /> Storage Location n n. <br /> m <br /> AAN <br /> SPECIAL PERMIT INFO. _ oslotted C <br /> Distance to sewer linesedan c $ <br /> Domestic well on site - yes/ <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Q nn <br /> Depth to water " O _ Casing type P"S <br /> Mix Ratios 44lenJ Blank ft. Screen /O ft. <br /> Installation Method Slot size U'/ <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 />