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MONITORING WELL IMSTAELATION REPORT <br /> Date: I " <br /> ONSTRUCTION <br /> Premise Address: 6u/ <br /> Well No. - Sf <br /> Inspector• Total Depth_. SS�_ •• <br /> Green Length <br /> filter Pack <br /> entonite Pellets -8 G <br /> Permit No. Crout - L <br /> Consultant L'oCompletion-Stove pipe/ ristie box <br /> Geologist f <br /> Auger O.D. /d., co <br /> Auger I.D. r 2 S# <br /> SAMPLING _. <br /> Holding Temperature '� stick-up <br /> Method <br /> Screening Method p ✓,>" T <br /> -GROUND CHRISTY-Box <br /> Tracking Sheet y n) DOMPLETION COMPLETION <br /> Ground Surlacs <br /> SPOILS <br /> grout <br /> Storage Method <br /> Contamination Noted -: (2a/no ' <br /> «•x�-�—tt• <br /> Storage Location ,gyp • ft• <br /> p <br /> SPECIAL PERMIT IKrO. <br /> 0 <br /> Distance to sewer line 14/4 = B <br /> section <br /> Domestic well on site - yes/no = qmviW P <br /> ack <br /> If yes, location & distance <br /> GROUTING <br /> 16MTERIALS USED: <br /> Depth to water �rL axing type__ZYt✓_ ZCij Frn <br /> Mix Ratios lank—,ZC ft. Screen y.l ft. <br /> Installation Method .ca- 3lot size__ <br /> Quantity Installed 3ags cement <br /> uckets bentonite—A <br /> ags sand/gravel !g_ <br /> filter Pack size_fL14,_,_'j'T44 MAL 4 <br />