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1 <br /> OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date•• CONSTRUCTION <br /> Premise Address: , / <br /> ( /f/�' Well No. V / <br /> ,✓a� <br /> Inspector: Total Depth <br /> Screen Length 9 G <br /> Filter Pack <br /> Bentonite Pellets lr <br /> Permit No. Grout <br /> Consultant -Stov pipe istie box <br /> e- <br /> Geologist �v �trY✓l�`n <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> stldt-up <br /> Holding Temperature_i C- <br /> Method VV, <br /> Screening Method ... <br /> ABOVE-GROUND CHRISTI(-BOX <br /> Tracking Sheet (Y&- <br /> n. COWPLETION COMPLETION <br /> Around Surface <br /> SPOILS <br /> grout <br /> Storage Method1217 <br /> `s <br /> Contamination Noted yes/ ' <br /> Storage Location �� <br /> iii 5i �✓��� <br /> a <br /> SPECIAL PERMIT INFO. _ <br /> 0 <br /> slotted = c <br /> Distance to sewer line section "- <br /> Domestic well on site - y /no = grave[p� <br /> If yes, location & j ist ce - _ <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casin=--i-t-- screen--Z-3--ft. <br /> Mix Ratios Blank <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />