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"AGE <br /> Iwo, —t— <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: J 1 Well No. hi <br /> w <br /> Inspector: 2A Total Depth 3(o.5 <br /> Screen Length p <br /> Filter Pack X311 <br /> Bentonite Pellets 3 <br /> Permit No. <br /> 30 Grout I <br /> Consultant Completion-Stove.. pi christie box <br /> Geologist_ <br /> Auger O.D. t7 <br /> Auger I.D. <br /> SAMPLING M <br /> Holding Temperak urI 0 V stick-up <br /> e <br /> Method <br /> Screening Method <br /> /►ROVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> SPOILS T <br /> Ground Surface —+ -- <br /> grout <br /> Storage Method - Ja ft. <br /> Contamination Noted - yes,/no f <br /> Storage Location <br /> 14 <br /> a <br /> SPECIAL PERMIT INFO. = o <br /> slotted = c <br /> Distance to sewer line section <br /> Domestic well on site - yes Pack <br /> If yes, location & distance - —' <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water a `J Casing type <br /> a C \j C' <br /> Mix Ratios ' Blank ft. Screen LID ft. <br /> Installation Method Slot size Da- <br /> Quantity Installed Bags cement 5 <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />