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• PAI41_oF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Well No. <br /> Inspector: Total Depth <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets <br /> Pe-:nit No. Grout <br /> Consultant Completion-Stove pipe/christie bez <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Folding Temperature �stck'up <br /> Method � <br /> Screening Method <br /> TrackingSheet r ABOVE,GRGUND CHFUSTY-BOX <br /> �' /n) 00&9L7ION CCMPLETION <br /> SPOILS <br /> Ground Surface f <br /> grout <br /> ' Storage Method <br /> Contamination Noted - yes/no - ft. <br /> Storace Location ft. <br /> n. <br /> `qC <br /> 0 <br /> SPECIAL PERMIT INFO, <br /> o <br /> dotted " = c <br /> Distance to sewer line aac�on '� _ $ <br /> Domestic well on site - yes/no <br /> If ves, location & distance - w; _ gravWP-ck <br /> �n <br /> ft. = ft. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type <br /> Mix Ratios � , <br /> 3_an.c ft. Screen `t <br /> Installation Method Slot size <br /> Quant' ty Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> . filter Pack type/size <br /> :)tal Billed Time Per Site <br /> ite Permit Finalized <br />