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� r J <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Well No. <br /> Inspector:--- Total Depth 0 <br /> (, • Ecreen Length •?.a- <br /> filter Pack ` <br /> entonite Pellets__ <br /> Permit No. Crout 41 3KI <br /> Consultant g Completion-Stove pipe/ hristie box <br /> Geologist <br /> Auger O.D. /d <br /> Auger I.D. <br /> `--- � <br /> SAMPLING <br /> r <br /> Holding Temperature atfdc•up <br /> Method <br /> Screening Method -Y'G V S-IV. x' T <br /> ..VE-GROUND —TWT <br /> Tracking Sheet (y chi _ C •BO <br /> MPLE UM COMPLETION <br /> .� <br /> Graund Surface <br /> SPOILS <br /> 9r01A <br /> Storage Method o c r`r �• <br /> Contamination Noted - yes cn <br /> Storage Location S it. <br /> 0 <br /> SPECIAL PERMIT INFO. <br /> a <br /> / <br /> Distance to sewer line Womda�ctioa > <br /> Domestic well on site _ yesno ) grawd P <br /> ack <br /> If yes, location & distance - <br /> ft. ft. <br /> GROUTING <br /> 14ATERIALS USED: <br /> Depth to wateracing type_ _SG ! rS� �l <br /> Mix Ratios !$ ,.,, ;.3 lank SS ft. Screen 4e -S- ft. <br /> Installation Method 3lot size _O, O ?--- <br /> Quantity Installed 3age cement <br /> ucket entonite IV <br /> age san gravel `, S <br /> ilter Pack type/size 46 <br />