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MONITORING WELL INSTALLATION REPORT <br /> Date: 1lw e D CONSTRUCTION <br /> Premise Address: SY 9/ F s7` Well No. M <br /> Inspector: wo4 Total Depth ay �y <br /> Screen Length .20- '0 '�S- <br /> Filter Pack <br /> Bentonite Pellets / <br /> Permit No. 90- 1112 Z Grout <br /> Consultant Completion-Stove pipe/ ristie b <br /> Geologist_ 14aQc_// rtf' r 4s <br /> Auger O.D. all <br /> Auger I.D. Y " <br /> SAMPLING <br /> Holding Temperature /' atk*-up <br /> Method a&a Cac�sffc % c <br /> Screening Method ZhE66� v 6c T <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet &n) COMPLETION <br /> COMPLETION <br /> SPOILS Ground Surface + r <br /> groutStorage Method 2 �• <br /> Contamination Noted - ye /no <br /> Storage Location nd s, a <br /> T <br /> O <br /> SPECIAL PERMIT INFO. — <br /> '- o <br /> c <br /> Distance to sewer line Wi��on — B <br /> Domestic well on site - yes/no graP <br /> ack <br /> If yes, location & distance - <br /> n. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water /d Casing type e ,2� SCA' 1/0 ?VC- <br /> Mix Ratios y " Blank �V, 3Y ft. Screen 20.OYft. <br /> Installation Metho Slot size / ci <br /> Quantity Installed Bags cement 2— <br /> Buckets bentonite Ila. <br /> Bags /gravel � <br /> an <br /> Filter Pack type/size'6"-3 �., <br />