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IAW <br /> Z OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date : / • / p• CONSTRUCTIONS/ ' - I <br /> Premise Address : //,1.� (N' OR4r Well No . /` 7113 <br /> Inspector • Total Depth !(o ' <br /> Screen Length <br /> Filter Pack . F -wll //a <br /> Bentonite Pellets . 3 a . 8 <br /> Permit No . 9! ' f�(n®v Grout O � i3 <br /> Consultant Completion-Stove pipe / christie ox <br /> Geologist , &t <br /> Auger O . D . <br /> Auger I . D . <br /> SAMPLING <br /> atldaup <br /> Holding Temperature <br /> Meetthoodd QOyY-L <br /> Screening Method /D <br /> ABOVEGROUND CHRISTY BOX <br /> Tracking Sheet y n ) OOWLETION COMPLETION <br /> „�� Ground Surface <br /> SPOILS <br /> proof <br /> Storage Method � V �6 <br /> Contamination Noted - es no <br /> Storage <br /> IF <br /> Fa <br /> e <br /> SPECIAL PERMIT INFO . _ <br /> 0 <br /> �/6 dotted = 8 <br /> Distance to sewer line k� section = <br /> Domestic well on site - es no = gravelpack <br /> If yes , location & distance - <br /> _ 6e !So ' <br /> % <br /> GROUTING <br /> MATERIALS USED : <br /> � , . ✓ c <br /> Depth to water � 5 Casing type r <br /> Mix Ratios Blank / ft . Screen /S ft . <br /> Installation Method Slot size , USO <br /> Quantity Installed Bags cement <br /> Buckets bentonite 3j <br /> Bags sand / gravel y� '✓`Y <br /> Filter Pack type / size_43 ..3 <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />