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MONITORING WELL INSTALLATION REPORT <br /> Date: .9� /Z a CONSTRUCTION <br /> Premise Address: S-191 %° sf Well No. M W- <br /> Inspector: C. Lv, n/ Total Depth ZY, <br /> Screen Length W C, a� <br /> Filter Pack <br /> Bentonite Pellets / � <br /> Permit No. 90 - /YLZ Grout el <br /> Consultant7'z':gd Completion-Stove pipe/Christie bo <br /> Geologist_ 1w.'tRa �,elrnxfS <br /> Auger O.D. S` <br /> Auger I.D. y" <br /> SAMPLING <br /> Holding Te perature y°Q, stick-up <br /> Method_3 ak, !� C'e,A i.,fi Y. <br /> Screening Method 7` T <br /> ABOVE-GROUND CHRISTY•BOX <br /> Tracking Sheet /n) COMPLETION <br /> COMPLETION <br /> SPOILS Gmund <br /> Surface <br /> proal <br /> Storage Metho o <br /> Contamination Noted - e /no q n• <br /> Storage Location a,., . <br /> 7 n, <br /> .�(t. <br /> '- ze <br /> SPECIAL PERMIT INFO. _ <br /> slotted B <br /> Distance to sewer line <br /> section <br /> Domestic well on site - yes/no <br /> grave!pack <br /> If yes, location & distance - <br /> Z� = z fin. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water �O Casing type 2" sc// 4/(_) ?VC. <br /> Mix Ratios Yy! Blank S ft. Screen 20, D W ft. <br /> Installation Method Slot size_ o. <br /> Quantity Installed Bags cement 2- <br /> Buckets bentonite I <br /> Bags 9and ravel <br /> Filter Pack type/size'03 <br />