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MONITORING WELL INSTALLATION REPORT <br /> Date: 0T 3�-I/C� CONSTRUCTION <br /> Premise Address: Well No. W — <br /> �l 'Ji <br /> Inspector: Total Depth <br /> Screen Length —P " <br /> Filter Pack <br /> Bentonite Pel eta <br /> Permit No. YO Z�i7 Grout � —+� L7 <br /> Consultant Completion-Stove pipe/christie box <br /> Geologist i <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperate <br /> Method /<'C.' <br /> �Yckup <br /> Screening Method J. <br /> --J� <br /> Tracking Sheet (y/n) ABOVE-GROUND W <br /> CBON <br /> COMPLETION MPLE1 <br /> COOMPLETION <br /> SPOILS 010"S <br /> Y� <br /> Storage Method <br /> n. <br /> Contamination Noted -! esjno <br /> Storage Location <br /> .wlua <br /> SPECIAL PERMIT INFO. •«von —_ <br /> — pn.J patic <br /> I E <br /> Distance to sewer line JC <br /> Domestic well on site - yes�r70, <br /> If yes, location & distance - —n. n. <br /> GROUTING MATERIALS USED: <br /> Depth to water 5S Casing t � I VL <br /> Mix Ratios Blank 4� ft. Screen_ ft. <br /> Installation Method 00ll I(�-- slot size 2-0 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />