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MONITORING WELL INSTALLATION REPORT <br /> Date: -7 IzIel u CONSTRUCTION <br /> Premise Addres • Well No. M43 - 1 <br /> col 3 l �%a GlFY C <br /> Inspector: Total Depth <br /> c7- S (SYI Screen Length ` -y7 - <br /> Filter Pack - <br /> n �L Bentonite Pel/1��ts - 3 -� <br /> Permit No. 76 -� UJ Grout -`F-� 0 <br /> Consultant 4LAZ34 Completion-Stove pipe/christie box <br /> Geologist <br /> Auger O.D. f <br /> Auger I.D. <br /> SAMPLING ,�pp <br /> Holding Temperature <br /> Method— <br /> Screening Method <br /> Tracking Sheet (y/n) A OVE-GROUNo <br /> COMPLETION COMPLETION <br /> ChWILEDO% <br /> N <br /> SPOILS <br /> af� <br /> Storage Method "�� <br /> Contamination Noted - a'no �1 n• <br /> Storage Location <br /> CVU � <br /> SPECIAL PERMIT INFO. -_ <br /> Distance to sewer line _= <br /> Domestic well on site - yes fiib <br /> If yes, location & distance <br /> GROUTING �C MATERIALS USED: ,,� A <br /> Depth to water :J� Casing 1x%4 7'L• /v� <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size 0• D-7,0 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size 3 <br />