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MONITORING WELL INSTALLRTION REPORT <br /> Date: �l `� CONSTRUCTION <br /> Premise Address: C✓C'�r� Well No. /Mj 7 <br /> Inspector: Total Depth 'T <br /> 11 <br /> ri Screen Length 3'/3 <br /> Filter Pack 35__ // <br /> Bentonite Pellets - <br /> Permit No. / Grout <br /> Consultant y-161A e s Completion-Stove pi Christie box <br /> --------------- <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> Holding Temp;2— <br /> . 'e k�� ddt-w <br /> Method. 7� SL"�,r' W.. <br /> screening Method T <br /> AN)VE43ROUND CI*iOMBOX <br /> Tracking sheet (y COMPLETION COMP6ETMN <br /> SPOILS OrsvAd Sufaw <br /> 11 <br /> WWA <br /> Storage Method <br /> ContaminatLon Noted - yes/no <br /> Storage Location ' <br /> SPECIAL PERMIT INFO. <br /> el <br /> Distance to sewer line sv x <br /> Domestic well on site - yes/ &__' _ <br /> If yes, location & distance - <br /> x,' <br /> GROUTING <br /> MATERIALS USED <br /> Depth to water /7 Casing type <br /> Mix Ratios Blank ft. Screen Ga ft, <br /> Installation Method Slot size Z <br /> Quantity Installed Bags cement <br /> Buckets bentonite Z ,, S A; <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> C(OPY <br />