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MONITORING WELL INSTALLATION REPORT <br /> Date:- ,�� 1�� / CONSTRUCTION <br /> Premise Address: I/e O!t ti well No. - <br /> Inspector• ��a., - _ Total Depth ' , <br /> Screen Length 0d <br /> "-r /4#11 Filter Pack el ' <br /> Bentonite Pellets S <br /> Permit No. Grout %=L <br /> Consultant 6,-.r Completion-Stove pip Christie box <br /> Geologist t <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature % C stick-up <br /> Method C e tsle,4 ct <br /> Screening Method //- y T <br /> ABOVE-GRO(JND CHRISTY-BOX <br /> Tracking Sheet y n) COMPLETION COMPLETION <br /> Gmund Surface <br /> SPOILS <br /> grout <br /> Storage Method S✓o fi �-1�W/ �. <br /> Contamination Noted '- yes/ o <br /> Storage Location 0.3 S: _ n• <br /> �•P PE I�`INFO. ... ..., > `� � �d� <br /> rF• .n flYtt� <br /> Distance to sewer line Co-,l . W1 <br /> aarr.dw . <br /> Domestic well Yon• site - -yes rto W"paa <br /> If yes, 4acation-& diayance .. ."' <br /> GRWI <br /> IIATSRIALS USED: <br /> Depth`,to water 6 Casing type_ -L'CA e,1() .,Pyr- <br /> y�� <br /> Mix Ratios Blank ft: Screen ft. <br /> Installation Method Slot size 0 - O/ <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />