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OPE�OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: y CONSTRUCTION <br /> Premise Address: SILK�r✓ Well No. /11% 7 <br /> Inspector: Total Depth <br /> Screen Length S- <br /> Filter Pack <br /> Bentonite Pellets — <br /> Permit No. Grout ::� / - S <br /> Consultant Completion-Stove pi ri is box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING - <br /> Holding Temperature stldaup <br /> Method Iff a <br /> VDI vj�;F— <br /> Screening Method go T <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) COMPLETION <br /> COMPLETION <br /> Ground Surface <br /> SPOILS I <br /> grout <br /> Storage Method <br /> Contamination Noted - yes/no ft' <br /> Storage Location ft <br /> ft. <br /> m <br /> P <br /> O <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> slotted — c <br /> Distance to sewer line secoon <br /> Domestic well on site - yes/no _ gravel ad, <br /> If yesr location & 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 /> Total Billed Time Per Site <br /> Date Permit Finalized <br />