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S —OF 2- <br /> MONITORING W0.LI, INSTAW ATION REPORT <br /> M ' <br /> Date: �ZZ `l NST CTION <br /> Premise Address: /32o i' --{, Well No. <br /> 7'X� S <br />>f Inspector: �J� - "3 Total Depth 13's , <br /> Screen -:?% - A. <br /> Filter Pack -43 3 - 2 <br /> Bentonite Pellets <br /> Permit No. Grout - <br /> Consultant W 1AF Completion-stove pip Christ=box <br /> Geologist a o. - — <br /> Auger O.D. /O i <br /> x, Auger <br /> -1.D. <br /> SAMPLING <br /> � 1 <br /> Holding Temperature- Noe- c.Q- *e stir-up <br /> Method____-* <br /> Screening. Method <br /> ABOVEdiROUNO CHRjS7Y460X <br /> Tracking Sheet (y/4a-) . COMPLETION COir�ICN <br /> ,x <br /> ceoundds:rtac. <br /> s <br /> rc�✓��lv� !/� grout <br /> Storage Method 04 ��`- rx� ✓ ��.s��. ii <br /> Contamination Noted --a%Wno 'Ins �v-- r 40r� rZ <br /> Storage Location <br /> SPECIAL PERMIT INFO. ® s <br /> ' Distazid?. to,sewer line aeon <br /> Domegt.ic well on site - yes/e> pack <br /> If yesv location & diatance <br /> ti <br /> n. <br /> GROUTING <br /> ' MATERIALS USS s <br /> f/G y <br /> Depth to water � // Casing t e _ <br /> Ile <br /> Mix Ratios . ATS Blank €t. Screen Z-0 €t. <br /> Installation mikhodi C `Slot size <br /> Quantity Installed .� Bags cement _ <br /> Bucket S.>bentonite <br /> Bags sand/gravel <br /> Filter-Pack type/si 4 <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />