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PAGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: :;/z,-i,- I/ Y CONSTRUCTION <br /> Premise Address: 14445-bui %. Well No. SL.WL InJ - �ZK} <br /> Inspe Ct Or: JN;AAAra Total Depth <br /> Screen Length <br /> Filter Pact: ?* <br /> Bentonite Pellets Z,' <br /> Permit No. Grout 6 <br /> Consultant S fr^„ Alrc- _ Comoletion-Stove pipe/christie box <br /> Geologist Codi tA I%Af w <br /> Auger O.D. <br /> auger I.D. <br /> SAMPLING <br /> att �p I <br /> Folding Temoerater g: <br /> Method <br /> Scree-ino trod <br /> A B0VE,GRQUND C}ifllslYK30X <br /> Tracking sheet (_y/n) cOWLETIGN COMP=]ON <br /> Crcurzl Svrtzcs <br /> SPOILS <br /> pp Act <br /> Storage Method fi�/lus <br /> Contamination Noted - yes/no ft. <br /> O K. <br /> Storace Location Jz n <br /> — m <br /> SPECIAL PERMIT INFO, — c. <br /> 0 <br /> alotted <br /> Distance to sewer lire sadon <br /> Domestic well on site - yes/no Pzd� <br /> If ves, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> Deoth to wa ��c <br /> ter Casing type <br /> Ml:c Ratios Blank 12 ft. Screen 15; ft. <br /> I:lstallation Method drryw.acl Slot size • O10 <br /> Quantity Installed N to Baas cement 3 <br /> Buckets bentonite <br /> Bags sand/gravel Ir <br /> Filter Pack type/size 2 jl2 <br />