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' 1 <br /> OF 2j <br /> a <br /> MONITORING WELL INSTALLATION REPORT <br /> 00 <br /> Date: w 'M CONSTRUCTION <br /> Premise Address: 6AV tr Well No. ' <br /> Inspe�to s= Total Depth .3 <br /> Screen Length 3" <br /> Filter Pack �y <br /> /n? Bentonite Pe)'--*-s <br /> Permit No. ro - f,42 t.) 'Grout 2- `—. <br /> Consultant Completion--Stove pipe/ hristie bo <br /> Geologist Lags rar <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature <br /> stick-up <br /> Method_ <br /> Screening Method <br /> ABOVE-GaouND <br /> Tracking Sheet n) OOMPLUiON COMPLETION <br /> Ground Surface <br /> SPOILS {out <br /> j <br /> _ <br /> Storage Method e, � <br /> Contamination Noted 4'Ve'Oho <br /> Storage Locgti on � <br /> p <br /> SPECIAL PERMIT INFO. o <br /> slotted l <br /> Distance to sewer line Z60 section <br /> Domestic well on site -ds�no , qmvei pack <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: r <br /> i <br /> Depth to water Casing type- AIC, 2 ti <br /> {3 <br /> Mix Ratios faL.1�- Blank een ft. <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size Z-r <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br /> l <br /> k Ei <br />