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k <br /> ` , t <br /> V � <br /> i <br /> MONITORING WELL INSTALLATION REPORT ' <br /> Date:T/a'/ qt qq ���� CONSTRUCTION <br /> Premise Address: & A)'1!x- well No. <br /> Inspector: Total Depth Lo <br /> Screen Length 2-0 <br /> Filter Pack <br /> Bentonite Pellets Z S <br /> Permit No.7 /- l Z-8b - Grout <br /> Consultant C#2-At FdlL Completion-Stove pipe/ hristie b x <br /> Geologist/ <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING - - ----- -- <br /> HoldingTem erature ��� atldrap <br /> Method. (�-7 IffT <br /> Screening Method P10 KA <br /> ABOVEGROUND HRISTY BO% <br /> Tracking Sheet /n) C <br /> , COMPLETION CHRISTY X <br /> SPOILS <br /> grcxA <br /> r Storage ht. . ,,4/ <br /> - <br /> Contamination <br /> Noted a no -'�•��n• <br /> Storage Location—✓1-LZE n• <br /> e <br /> SPECIAL PERMIT INFO. ,+ <br /> � — c <br /> Distance to sewer line SU uoeyon <br /> Domestic well on site - ye _ �� <br /> If yes, location & distance - — <br /> pok <br /> qu n j ota Iu <br /> GROUTING - <br /> MATERIALS USED: <br /> L <br /> Depth to water ` 2- 3 Casing type 7 dr U <br /> Mix Ratios �' Blank, ft. Screen Y_bft. <br /> Installation Method Slot size •-U'L ' <br /> Quantity Installed T Bags cement I ?- cf I <br /> Buckets bentonite 115- <br /> . Bags sand/gravel Ei 4107 <br /> Filter Pack type/size 03 Sc. X, <br />