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F <br /> E � OF <br /> a <br /> A <br /> ` <br /> A J MONITORING WELL INSTALLATION REPORT <br /> Date: f L ` / CONSTRUCTION <br /> Premise Address: 9190G, /Z well No. <br /> Inspector• Total Depth <br /> Screen Length <br /> Filter Pack JO f— ? <br /> Bentonite Pellets 2 Z ^-'• <br /> Permit No. /~ v� rout c>,— 4 <br /> Consultant /y/a/ vrU omple io -Stove ipe christie box <br /> Geologist <br /> Auger o. <br /> ager I.D. <br /> SAMPLING <br /> itlCl(itQ <br /> Holding Temper ture <br /> Method C7 <br /> Screening Method <br /> ..NE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y DOWPLETION COMPLETION <br /> Ground Surface <br /> SPOILS ` <br /> L grout <br /> Storage Method <br /> Contamination Noted - no 14-02 <br /> Storage Location <br /> - p <br /> O <br /> SPECIAL, PERMIT INFO. o <br /> cam!' ht r slotted <br /> Distance tower line Za seCton _ <br /> Domestic well on site - yes no .~ �y�pack <br /> If yes, location & distance <br /> —ft. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to wat r ' Casing y e <br /> Mix Ratios 1�r�� Blank ft. Screen 15ft. <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 />