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PAd*_0F <br /> MONITORING WELL INSTALLATION REPORT • <br /> Date: I 2' CONSTRUCTION <br /> Premise Address: zS S• f1lsau> Well No. <br /> Inspector: Total Depth 117 <br /> Screen Length 2 -04 110 - 112 Pf d�.Fl) <br /> Filter Pack loll - 117 A <br /> Bentonite Pellets loll-101 �f <br /> Permit No. SK 00(LG o 22 Grout I - ID pf <br /> Consultant �llOMl3['S Completion-Stove pipe/dIr.* box .. <br /> Geologist- Auger O.D. F incl, <br /> AtL- �'Q AGI a# Auger I.D. 4.,T' #'mack -- <br /> SAMPLING <br /> _ �stick-up <br /> holding Temperature <br /> Method <br /> Scree..^.ing Method <br /> ABOVE-,GROUND CHRISTY•BOX <br /> Tracking Sheet (y/n) OCWi-RAN COMPL-TION • <br /> -_ GwndSurlxa <br /> SPOILS <br /> grout <br /> pig <br /> Storage Method T)2jA0 5 <br /> Contamination Noted - yes/no K, <br /> Storage Location J�•f}, <br /> a <br /> SPECIAL PERMIT INF = o' <br /> slotted = B <br /> Distance to sewer ine wcdcn <br /> Domestic well o sit_ - yes/no 7"pack <br /> If yes, locati n & distance - ` <br /> RE = <br /> .. tt. <br /> Sl.mp <br /> GROUTING 11-7fE <br /> MATERIALS USED: <br /> Death to water Casing type SA 90 <br /> Mix Ratios— �'f1!>s'6f J7G'• "5 Blank 110 ft. Screen Z ft• <br /> Installation Method Slot size <br /> Quantity Installed Bags cement \ <br /> Buckets bentonite w SO J <br /> Bags sand/gravel da 6lL) • <br /> Filter Pack type/size 'Llit Ssj <br /> Dtal Billed Time Per Site <br /> stn Permit Finalized <br />