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GE OF I <br /> - <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: r "tom ___ CONSTRUCTION <br /> Premise Addre se, lq� 7- �� IJD� �� well No.1-3 <br /> Inspector: -- <br /> _ Total Depth <br /> i- Screen Length <br /> el <br /> Filter Pack <br /> Bentonite lets <br /> Permit No. Grout V` CJt <br /> "� <br /> Consultant Completion-Stove pi a/Christie b x <br /> Geologist <br /> Auger O.D. h <br /> Auger I.D. <br /> SAMPLING <br /> e @**-UP <br /> Holding Temperature r <br /> Method� ��,/ �� cJY" _ <br /> Screening Method ,_ <br /> ABOVE-GROUND CHRIS7Y4M <br /> Tracking Sheet(! n) COf,�WLETlON COMPLETION <br /> Ground Surfws i <br /> SPOILS s <br /> Smut <br /> Storage Method e <br /> Contamination Noted - e /n 11 ff3 �1� Z N6) . <br /> Storage Locatioj� �. <br /> p � <br /> SPECIAL PERMIT INFO. _ o <br /> � slorios3 � <br /> Distance to sewer'r line z_S� aecpon <br /> 16 pack <br /> Domestic well on ;Isite - yesT, <br /> If yes, location '!& distance <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water .i Casing ty e <br /> Mix Ratios Blank � U ft. Screen I& ft. " <br /> Installation Method Slot size b �.b <br /> Quantity Installed 9 'A'_AJ, Bags cement <br /> Buckets bentonite .��� <br /> Bags sand/gravel �. <br /> Filter Pack type/sze <br /> Total Billed Time Per Site <br /> Date Permit Finalized (ing-A-7 <br /> / <br /> ,a. <br /> v� <br />