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MONITORING WELL INSTA LATION REPORT <br /> Date i 17117 ' 5--0 C NSTRUCTIO <br /> Premise Ad esss 1 �,1 Well No. V- 3 <br /> Inspectors Total Depth A S""' <br /> Screen Length 1 <br /> Filter Pack —s-i= <br /> Permit No. Bentonite Pellets <br /> Grout <br /> Consultant Co pletion-Stove pipe fstie box <br /> Geologist <br /> Auger O.D. /d• �� <br /> 4uler I.D. <br /> � LiN[i <br /> 0 <br /> Holding Temperature „ <br /> Method <br /> .pc#vp <br /> Screening jiethod <br /> Tracking Sheet /n) ru►ov�cHouNp <br /> COI.WLMON G11HiSiY-box <br /> GOMPLEYkOFI i <br /> SPOIL'S <br /> Storage Mgthod S/o --/ <br /> contamination Noted <br /> Storage Lec.ation <br /> -r <br /> SPECIfiL P4AMIT THFO. ; — A <br /> Distance to sewer line <br /> Domestic well on site - yes/no <br /> If yes, location & distance - �S s• — n. <br /> GROV21M TE IALS USED: <br /> Depth to water M 44. casing type VC SC/?! <br /> Mix Ratios'41f6z cAle .1s 3 rAldej Blank_ ft. Screen 4-S ft. <br /> Installatiq" Method _ Slot size <br /> C2 Ld <br /> Quantity I#stalled Bags cement • Z <br /> Buckets bentonite- <br /> Bags <br /> entoniteBa s sand/gravel 2 c7 <br /> Filter Pack type/size At UfA <br />