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-`------- ^ <br /> A 1A0A <br /> MONITORING WELL INSTALLATION REPORT � V3 <br /> S S <br /> ZY <br /> Date: riz��� �I I CDNSTRUCTIDN <br /> Premise Addre s: 5y0A, &14Mc✓ well No.-11f/,1dz <br /> Inspector: 'total Depth -7-7 _ <br /> Screen Length <br /> Filter Pack. <br /> 'Bentonite Pellets / <br /> Permit No. Grout l:e <br /> Consultant a Completion-Stove pip ./christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> 5 <br /> Holding Temperature 7 °� sUck-up <br /> Method /3.ca,1j rLA� <br /> Screening Method w ,. <br /> ABOVE-GROUND CHRISTY43OK <br /> Tracking Sheet (y/ ) OOMPLETION COMPLETION <br /> Gm and Suriacs <br /> SPOILS <br /> groin <br /> Storage Method - (&:;&(-, <br /> .Contamination boted - _ye no <br /> Storage Location` ft' <br /> d <br /> SPECIAL PERMIT INFO. w = C <br /> 6106d <br /> Distance to sewer line sactlon <br /> Domestic well on site - yes no gmvW <br /> pack <br /> If yes, location & distance - -- <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water b-63 Casing_ type-_?L)C/ <br /> Mix Ratios A.ZBIari;rz ft. Screen .75ft. <br /> Installation Method Slot size 0 <br /> Quantity Installed _-/ LIc� Bags cement 2 <br /> Buckets bentonite <br /> Bags sand/gravel Z <br /> Filter Pack type/size . <br /> m�rrC_7�i7 <br /> E <br />