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"AGE_Z OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: .30 _ CONSTRUCTION <br /> Premise Addr ss:(G� GJ Well No. 3 <br /> Inspector• Total Depth <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. 0- /Z? Grout <br /> Consultant Completion-Stove pipe/christe <br /> Geologist f' <br /> Auger O.D. U `L <br /> Auger I.D. <br /> SAMPLING (� <br /> Holding Tem era re r stldti'p <br /> Method1L� f <br /> Screening Method Ad--A- <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y n) OOMPLETION <br /> COMPLETION <br /> SPOILS Ground Suriecs__+ -- ..�� <br /> � QQ praut <br /> Storage Method <br /> Contamination Noted yes no ft' <br /> Storage Location,-•c2ti�z„ �J ft. ft' <br /> _ m <br /> P <br /> m <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> slotted c <br /> Distance to sewer linelo section _ <br /> Domestic well on site - yes/ _ qmP <br /> ack <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED <br /> Depth to water /�ltZ Casing type/ <br /> Mix Ratios Blank — ft. Screen -'- ft. <br /> Installation Method Z- Slot size .UO7- <br /> Quantity InstalledAq- 2 " Bags cement oe—" <br /> Buckets bentonites <br /> Bags sand/gravel. t <br /> Filter Pack type/size 3 <br /> Total Billed 'Time Per Site <br /> Date Permit Finalized <br />