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.-: * -\tGE OF <br /> MONITORING WELL INS/T]ALLATION REPORT <br /> Date : ' CONSTRUCTION <br /> Premise Address :/ 1 .4e01�w1 Pi Well No . VV <br /> Inspector : Total Depth <br /> I . Screen Length <br /> Filter Pack <br /> Bentonite Pew is <br /> Permit No . I Grout <br /> Consultant • Completion-Stove ,. pip / christie x <br /> Geologist _ . & <br /> Auger O . D . g <br /> Auger I . D . <br /> SAMPLING - --Y - - - - - - - <br /> Holding T.e�ympera�ture 1Uo FLa" atldaup <br /> Method 1"yC <.c�c tit L T <br /> T <br /> Screening Method <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet ( y/ n ) COMPLETION COMPLETION <br /> �� Ground Surface <br /> SPOILS f <br /> ,I ®rout I /�Z/ <br /> Storage Method MV <br /> Contamination Noted yes / no � fl. <br /> Storage Location Vk <br /> m <br /> SPECIAL PERMIT INFO . AbqE= <br /> dotted = qE <br /> Distance to sewer line aecion <br /> Domestic well on site - yes / no <br /> Wavel pack <br /> If yes , location & distance - <br /> 1B <br /> GROUTING <br /> MATERIALS USED : <br /> 1 <br /> Depth to water � ✓ Casing type `L <br /> Mix Ratios :� g Blank_ ft . Screen ft . <br /> Installation Method Slot size • � Z <br /> Quantity Installed IAOAA Bags cement <br /> Bucketntonite <br /> Bags sand ravel <br /> Filte ack type / size It 3 <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />