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E Z_ OF <br /> MONITORING WELL INSTALLATION REPORT <br /> W <br /> Date: r Z - <br /> .CONSTRUCTION Air <br /> Premise Address; '3 Gp_er Well No. <br /> Total 6 lITotal Depth / <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. - D 3 -A.)44 Grout - 1 <br /> Consultant w Completion-Stove pipe/ hristie box <br /> Geologist <br /> Auger O.D.- <br /> Auger <br /> SAMPLING I I <br /> Holding Temper tune <br /> 61 Lr,- i G� slldc-up <br /> Method Je4pflT <br /> T <br /> Screening Method <br /> ABONE43 KMO CHRISTY-BOX <br /> Tracking Sheet (y/&L- COMPLETION cOMPLEnON <br /> a muga Sudece + <br /> SPOILS aWA <br /> Storage Method -fL <br /> Contamination itoied - yes n , <br /> Storage Location ,moi <br /> SPECIAL PM T INFO <br /> C.J ' Notsed '. <br /> Distance to sewer line <br /> Domestic well on site - yesigo7 _ grsrNP89* <br /> If yes, location & distan <br /> �7 a ft, °� � it• <br /> GRO�ITING <br /> MATERIALS USED: <br /> S !/G <br /> Depth to water Casing <br /> Mix Ratios - Blank ft. Screen Z ft. <br /> Installation Method �' Slot siz <br /> Quantity Installed t f Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />