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w <br /> MONITORING WELL INSTALLATION REPORT <br /> Date:. CONSTRUCTION <br /> Premise Addr S ! Well No. OS5 #/ <br /> Inspector: Total Depth <br /> Screen Length ' <br /> Filter Pack <br /> /�/h q Bentonite Pellets 5 <br /> Permit No. `Z(/'zZ�4 Grout G¢•w••A <br /> Consultant Completion-Stove pipe/christie box <br /> Geologist A4 AfAA <br /> Auger O.D. <br /> Auger I.D. Z- <br /> SAMPLING <br /> Holdingemperature 4 aC stick-up <br /> Method A(yrs �„cc.luti <br /> Screening Method T <br /> AE;;V .GROUND <br /> Tracking Sheet (y n) COWPL•ET$ON C�PLFTBOGHRI5CY-BOX <br /> y <br /> SPOILS Ground Surfws <br /> wout <br /> Storage Method_ lJ� <br /> Contamination Noted /no -•� n• <br /> Storage Location-4 �3.�it. 8D tt- <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> Distance to sewer line-=&_ awdon = $ <br /> Domestic well on site <br /> if yes, location & distance - qra��pack <br /> &2-c- n >b g•S n. <br /> GROUTING <br /> MATERIALS USED: <br /> Q i <br /> Depth to water r y Casing type oc, <br /> Mix RatBlank 3_S ft. Screen .20 ft. <br /> Installation Method r Slot size w ?ZO T <br /> Quantity Installed V-47-Ao, ��au, �e,vxr Bags cement <br /> Buckets bentonite2y <br /> Bags sand/grave r #/0u 21 2 <br /> Filter Pack type/size <br /> 11f6 AZeA <br /> ,, _p 6 <br />