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v GE__L_OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: a A,?,1f,) CONSTRUCTION r <br /> Premise Address:&'r—a) itAoNOL"C Well No. HW <br /> Ins ector: Total Depth <br /> Screen Length " -3►' . <br /> Filter Pack " <br /> Bentonite Pellets <br /> Permit No.--7 o Grout - 4p-+ <br /> Consultant AhAfig&= Completion-Stove pip christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. 2 <br /> SAMPLING - — — - - -- <br /> e . atfdcup <br /> Holding T perature <br /> Method _- <br /> Screening Method <br /> ABOVE-GROUND CHRISTY-SOX <br /> Tracking Sheet 6Vn) COMPLETION COMPLETION <br /> (round Surir cr <br /> SPOILS <br /> //�� <br /> grout <br /> Storage Method 40" <br /> Contamination Noted e <br /> ft. <br /> Storage Location <br /> m <br /> a <br /> m <br /> SPECIAL PERMIT INFO. _ <br /> r* slottad <br /> Distance to sewer line >10 <br /> aac9on <br /> Domestic well on site _45>0 o gr&vW park <br /> If yes, locapion & distance - <br /> GROUTING <br /> MATERIALS USED: '� <br /> Depth to water Z ' Casing t pe SU- 41 `,/0 <br /> Mix Ratios Blank ft. Screenrep ft. <br /> Installation Method Slot size d <br /> Quantity Installed Bags cement _ <br /> Buckets bentonite _ <br /> Bags sand/gravel <br /> Filter Pack type/size Z <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />