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MONITORING WELL INST TION REPORT <br /> Date: y g� CONSTRUCTION <br /> Premise Address:-5'e/ Well No. /Q <br /> Inspector-.—U- Total Depth �J <br /> Green Length <br /> Filter Pack Z 7. <br /> entonite Pellets Z <br /> Permit No. Irout <br /> Consultant 72Completion-Stove pipe/ istiebox <br /> Geologist <br /> uger O.D. <br /> Auger I.D. 3 <br /> SAMPLING -.._ <br /> Holding Temperature y C- atkiaup <br /> Method <br /> Screening MethodX-L _ <br /> •. -GROUND CHRISTY•BOX <br /> Tracking Sheet y n) OOWPLETION COMPLETION <br /> C3=d Surfaces <br /> SPOILS <br /> / proal <br /> Storage Method •5m 1a <br /> Contamination Noted - e /no -'--„• <br /> Storage Location o J Si 7` n• <br /> a <br /> SPECIAL PERMIT INFO. <br /> A <br /> Distance to sewer line secdon _ <br /> Domestic well on site _ yes/nogmvel pack <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water �0 r Casing type ?,./C XC//-4"Q Z �� <br /> Mix Ratios �'�d,� ' t 3 ��� Blank 1 ft. Screen Z3' £t. <br /> Installation P16thod Slot sized. O Z. <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bagsnd gravel _ <br /> Filter ack type/size a �E <br />