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PAGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: G� U CONSTRUCTION <br /> Well No. 2-"W #L <br /> Premise Address: �0 � �� <br /> inspector: �'• o� Total Depth T3� <br /> Screen Length 25 � <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No.--20 Grout <br /> Consultant Completion-Stove pipe/c stiesbo <br /> GeologistA ��� - <br /> Auger O.D. <br /> Auger I.A. <br /> SAMPLING <br /> eC stldc-up <br /> Holding Temperature <br /> Method Ct.t,�X'e� <br /> Screening Method R <br /> CHRISTY-BOX <br /> COMPLETION COMPLETION <br /> Tracking Sheet 0 n) (aroundSurisce <br /> SPOILS 01ou1 <br /> Storage Method <br /> Contamination Noted <br /> Storage LocationCD <br /> CD <br /> A <br /> SPECIAL PERMIT INFO. = o <br /> slotted ` <br /> Distance to sewer line W, a ��'"vK section E <br /> Domestic well on site - yes 0 pravelpack <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type Sc/�y0 V C <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size - C!) / // <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 />