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MONITORING WELL INSTALLATION REPORT <br /> Date: --7/13 /10 CONSTRUCTION . / <br /> Premia Address- Well No. <br /> 013/ /� A(- ✓fit 7 <br /> Inspector: Total Depth <br /> S (�� Screen LengthW4!5'- - -2- <br /> Filter Pack - S -�-1 <br /> Bentonite Pellets -/J <br /> Permit No. Grout <br /> Consultant Completion-Stove pipe/christie box <br /> Geologist <br /> Auger O.D. J6 .ZSR <br /> Auger I.D. <br /> SAMPLING 4,6c- <br /> Method— <br /> �X{ <br /> Holding Temperature 4,6 - <br /> Method /G& <br /> Screening Method <br /> Tracking Sheet (y/n) AUOVE-GROUND <br /> ox <br /> COI&ue aCOMPLETION <br /> n LILMPLE <br /> SPOILS Oro"Solan <br /> palwl <br /> Storage Method '1'_n. <br /> Contamination Noted -4rfino f n• <br /> Storage Location <br /> �J 9 <br /> smwd = S <br /> SPECIAL PERMIT INFO. <br /> _— pruJ pads <br /> Distance to sewer line =_ <br /> Domestic well on site - yes/no <br /> If yes, location & distance - <br /> GROUTING MATERIALS USED: <br /> Depth to water Casing type 'Vco'f (�o PVL <br /> i <br /> Mix Ratios Blank_ ft. Screen ZO ft. <br /> Installation Method Slot size 6-020 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />