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3f <br /> f� <br /> I , <br /> MONITORING WELL INSTALLATION REPORT <br /> 1� - <br /> Date: L7_6I !: DECONSTRUCTION <br /> Premise Addre s: S Gv 6A-4,(� Well Na. <br /> r <br /> Inspector• Total Depth . <br /> i! ! Screen Length <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No.-1T(_ gout <br /> Consultant ! Completion-stove pipe/c ristie ox <br /> Geologist j <br /> g Auger O.D.7a <br /> ` F Auger Z.D. <br /> E SAMPLING _ <br /> Holding TemperaturegoC,, <br /> Methods ALri40 <br /> Screening Method _ <br /> !l ' •ABOVE-GRO(JND <br /> Tracking Sheet { n) <br /> �Ir1��LETIDN CHRISTY-BOX <br /> COMPLETION <br /> jp <br /> SPOILS ��Surface <br /> grout <br /> Storage Method " 3 <br /> VT <br /> Contamination Noted - yesLl <br /> on• <br /> Storage Location n. <br /> t� <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line ' <:_0 510 <br /> aclicn R>' <br /> Domestic well on site = yesno' <br /> pack <br /> If yes, location & distance - ° gravel <br /> 5 ly n. Z-0 n. <br /> GROUTING <br /> € MATERIALS USED: <br /> Depthto water ! Casing type' <br /> v�1/Ci <br /> Mix :Ratios ;'. Blank d� ft. Screen__I ft. <br /> Installation Method Slot size brZ U <br /> Quantity Installfed Bags cement <br /> Buckets bentonite <br /> 4 <br /> !; Bags sand/gravel-4! <br /> Filter Pack type/size. ';; <br /> (f <br /> ;s <br /> t <br /> r [ <br />