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NONITORING WELL. INSTALLATION REPOT <br /> • <br /> DatesZ" I CONSTRUCTION <br /> Premise Address: 6 • w Well No. 1� '� <br /> Inspector: Total Depth <br /> w-� Screen Length <br /> 10r- <br /> Filter Pack { O <br /> Benton to <br /> Permit No. t Grou <br /> Consultant Completion-Stove.pi ch <br /> Geologist <br /> F JAWA !�� �A Auger O.D. <br /> �C Auger I.D. <br /> SAMPLING __ �_ <br /> Holding Temperature <br /> Method <br /> Screening Method W.. 6 1W <br /> ABOVE-0ROtINO CHRIS" -BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> $ � R&A <br /> Storage Method <br /> Contamination Noted - es/Eo) ft. <br /> Storage Location ��. <br /> r <br /> SPECIAL PERNIT.1 <br /> Distance to sewer line Moon <br /> Domestic well on site _ yes no " -= � P <br /> If yes, location & distance <br /> VI <br /> Lft <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water� 112• Casing type 0 pVt, <br /> Mix Ratios Blank ft. Screen� ft. <br /> Installation Method Slot size ON <br /> Quantity Installed Bags cement <br /> Z <br /> ;M;gravel <br /> ntonite <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />