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PAGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: c-)C' 1f-U CONSTRUCTION <br /> Premise Address: Z/70 A2-.-9 rc Well No. <br /> Inspector: Total Depth 75 ' <br /> Screen Length � <br /> Filter Pack ?/ <br /> Bentonite Pellets <br /> Permit No. /5`O - Z Grout <br /> _ i <br /> Consultant ..q Completion-Stove pipe/ ristie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING -- — _ <br /> o $**-up <br /> Holding Temperature gV <br /> Method l <br /> screening Method V.- <br /> ABOVE-GROUND CHRISTYWX <br /> Tracking Sheet y n) COMPLETION COMPLETION <br /> Around Suriac9 + <br /> SPOILS <br /> // proof <br /> Storage Method- S/o��C� Jl_ <br /> Contamination Noted - ye <br /> Storage Location <br /> = a <br /> SPECIAL PERMIT INFO. <br /> D <br /> /' slotted C <br /> Distance to sewer line C section <br /> Domestic well on site - yes/ o gmvW pack <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type <br /> Mix Ratios Blank ft. Screen ft. <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 />