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( (,.,,�GE_J_OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date• 1 A V CONSTRUCTION <br /> Premise Adds. <br /> Well-No. <br /> ea <br /> Inspector: 0 J� Total Depth <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. Z3� Grout <br /> Consultant CRf Completion-Stove. pi a Christie box <br /> Geologist Q.1LPC*L_ <br /> c <br /> Auger O.D. <br /> • Auger I.D. <br /> SAMPLING - —_ - -- <br /> Holding Temperature stIck-up <br /> Method <br /> Screening Method tb <br /> ! .. v <br /> AJX JE-GROUND CHRISM-BOX <br /> Tracking Sheet On) COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> I Grout <br /> Storage Method <br /> Contamination Noted - es no ft. <br /> Storage Location - � �!r �_ft• ft• <br /> 1P <br /> 0 <br /> SPECIAL PERMIT INFO. c <br /> slotWd <br /> Distance to sewer line section <br /> Domestic well on site - yes, a _ tmvlWPack <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type " PVA <br /> Mix Ratios Blank j-)' _ ft. Screen__g�ft. <br /> Installation Method bLwwu Slot size .07— <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags an /gravel <br /> Filter Pack type/size 2— <br /> Total Billed Time Per Site <br /> Date Permit Finalized 7-13-gc) <br />