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MONITORING WELL INSTALLATION REPORT <br /> -3_ ��- �� <br /> Date: CONSTRUCTION <br /> Premise Address: �Cz/"V y v� Well No. ML✓ <br /> Inspector: Total Depth :3,0 <br /> ' <br /> f 4 7759! Screen Length /S— .3 0 <br /> Filter Pack____ V _/•� <br /> Bentonite Pellets <br /> Permit No. V Grout - c < <br /> Consultant Coal f 3 Completion-Stove pipe/ `istie b9x <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. G <br /> SAMPLING - ----- -- <br /> Holding Temperature <br /> stick-up <br /> Method ILL <br /> Screening Method 7/4 M <br /> ABOVEGROUND CHRIM_BOX <br /> Tracking Sheet (y/n) COMPLETION <br /> COMPLETION <br /> SPOILS Ground Surlace <br /> grout <br /> Storage Method__ <br /> Contamination Noted - yes/�fo`j <br /> Storage Location c 7 <br /> _ e <br /> SPECIAL PERMIT INFO. <br /> e <br /> jslotwd <br /> c <br /> Distance to sewer linesac• gon "— <br /> Domestic well on site - yes = gmvWpack <br /> If yes, location & distance - -' <br /> L Im <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water / Casing t pe �V' y C <br /> Mix Ratios Blank ft. Screenft. <br /> Installation Method Slot size z <br /> Quantity Installed Bags cement <br /> Buckets bentonite_2- e <br /> Bags sand/gravel <br /> Filter Pack type/size <br />