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MONITORING WELL INSTALLATION REPORT <br /> Dat e• Z�q1 CONSTRUCTION <br /> Premise Address: 7 U `" Well No. <br /> Inspector: :Tq Total Depth —00._<2 tE, a'w" S - <br /> Screen Length Zo' <br /> Filter Pack A0,t t.,o0_ <br /> IF/ _��2, Bentonite Pellets <br /> Permit No. Grout c W <br /> Consultant_LUff-t Completion-Stove pipe christieb9k) <br /> Geologist <br /> Auger O.D.f��/?�'' <br /> Auger <br /> SAMPLING <br /> Holding Temperature <br /> °L stick-up <br /> Method_Z "-,, <,wP,e rte/ <br /> Screening Method N A <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet On) COMPLETION COMPLETION <br /> SPOILS Ground Surface + ��— <br /> grout <br /> Storage Method tic9a - lbzl� <br /> Contamination Noted - yes no n• <br /> torage Location <br /> w <br /> SPECIAL PERMIT INFO. _ ,C <br /> _ o <br /> slotted -- <br /> Distance to sewer line section <br /> Domestic well on site - yesno = � l <br /> ack <br /> If yes, location & distance - .a. <br /> _ <br /> GROUTING �� � <br /> MATERIALS USE . <br /> Depth to water 2 - Casing type"Pd(_- <br /> Mix Ration n- Blank /7.s ft. Screen Zy ft. <br /> Installation Method Slot size_ a0 Z.0 <br /> Quantity Installed Bags cement /1/3465. <br /> Buckets bentonite (5-- <br /> Bags <br /> Bags sand/gravel <br /> Filter Pack type/size 3 <br />