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MONITORING WELL INSTALLATION REPORT <br /> Date• <br /> r ' / I CONSTRUCTION' �I <br /> Premise Address: ���LJ• Ci'\af er, Well No. L1 T <br /> Inspector: Total Depth CJ <br /> Screen Length <br /> Filter Pack <br /> s-7 Bentonite Pellets <br /> Permit No. Grout <br /> Consultant <br /> Geologist Completion-Stove pipe/ __laox <br /> ristie ) <br /> � --- <br /> Auger O.D. 111 <br /> SAMPLING Auger I.D. <br /> Holding Temperature S stk*i+P <br /> Method S'� �1� <br /> _.F, <br /> TTT <br /> Screening Method <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y COMPLETION COMPLETION <br /> SPOILS Gmund Sudwe + �.�� <br /> Storage Method <br /> a(XA <br /> Contamination Notedyes o <br /> Storage Location 306 7 <br /> n, <br /> SPECIAL PERMIT INFO. — <br /> Distance to sewer line S d Wo;ted = <br /> &*coon = <br /> Domestic well on site - yea/® <br /> If yes, location & distance - gravWpack <br /> GROUTING <br /> MATERIALS USED• <br /> Depth to water Casing type <br /> Mix Ratios / 5 SU Ss S Blank Z� ft. Screen Zy ft. <br /> Installation Method 10�1/e— Slot size . � <br /> Quantity Installed Ze ag Bags cement- <br /> �/ Buckets bentonite <br /> 6;1 {'��� Bags sand/gravel S11011 <br /> Filter Pack type/size <br /> �ticJ�t— / S ��• <br />