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MONITORING WELL INSTAUATION REPORT <br /> Date: 3 f C� ONSTRUCTION <br /> Premise Address: Well No. <br /> Inspector: Total Depth SrQ �. <br /> creep Length Z�'. $' <br /> filter Pack <br /> entonite Pellets <br /> Permit No. rout e <br /> Consultant Completion-Stove pipe rietie box <br /> Geologist ..w.aU <br /> Auger 0.D. <br /> Auger I.D. 3 /j. <br /> SAMPLING --------------- <br /> --- -- <br /> Holding Temperature stk*-up <br /> Method 6 <br /> Screening Method rna / —QV <br /> IVE-GROUND CHRISTY•BOX <br /> Tracking Sheet {y n MPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> �rouf <br /> Storage Method <br /> Contamination Noted - yes o ft. <br /> Storage Locatio _J223 .e L �• <br /> jr <br /> a <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line ? Wot� <br /> section <br /> Domestic well on site - yes _ gravw f <br /> If yes, location & distance - <br /> ft. — ft. <br /> GROUTING <br /> TERIALS USED: <br /> Depth to water facing type _s2 " ?VC -Ecil- VO <br /> Mix Ratios lank S.s ft. Screen zs. ft. <br /> Installation Method 3lot size C7 • Oz If <br /> Quantity Installed 3ags cement <br /> uckets bentonite / <br /> ags sand/gravel 7 `" <br /> Filter Pack type/size � __*.7 <br />