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*\ GE Z OF <br /> MONITORING WELL INSTALLATION REPORT <br /> /V dj C��? <br /> Date : ! � L ` ` CONSTRUCTION,{. <br /> Premise Ads : 3U �!^^[. Well No . 7i <br /> Inspector : dre4 4 Total Depth <br /> Screen Length 152 X17 <br /> Filter Pack <br /> Bentonite <br /> Permit No . Grout ' c ' <br /> Consultant bjVjqWLA04P Completion-Stove pipe Christie box <br /> Geologist <br /> Auger O . D . <br /> Auger I . D . <br /> SAMPLING <br /> Holding Tem erature stickup <br /> Method.+ r�f�A.t.P de=& <br /> Screening Method A)() 01h a <br /> ow iw <br /> ABOVEGROUND CHRISTY-BOX <br /> Track&Ug Sh et ( y / n ) COMPLETION COMPLETION <br /> Ground S e <br /> SPOILS <br /> � p grout <br /> Storage Method DX- cI�� � , � <br /> Contamination Noted - yes o � n• <br /> Storage LocationZMd.i.�- n' <br /> n rl <br /> SPECIAL PERMIT INFO . <br /> dE0 <br /> slotted <br /> Distance to sewer line section = <br /> Domestic well on site - yes no _ � .• ) 7 <br /> ack <br /> If yes , location & distance - gmvel P <br /> 17n. = n. <br /> GROUTING <br /> / MATERIALS USED : <br /> Depth to watery Casing type 7i ` qC� <br /> Mix Ratios DSAWK4 Blank -'2i ft . Screen l ft . <br /> Installation Method Slot size Z <br /> Quantity Installed Bags cement <br /> Buckets tonite <br /> Bags sand ravel <br /> Filte ack type / size 7J <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br /> 3 26 �/ tel) z <br />