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PAO OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Well No. <br /> Inspector: Total Depth <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. Grout <br /> Consultant completion-Stov pipe/christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> TsticScup <br /> Holding T_emcerature t <br /> Method <br /> Scree.^.ing Method <br /> ~VE,GACUND CNAISiY-BOX <br /> Tracking Sheet (y/n) CCWLFI'ICN COMPLETION <br /> Gcound Sulace <br /> SPOILS \ "rout <br /> Storage Method �__ft. <br /> Contamination Noted - yes/no ft. <br /> Storage Location <br /> _ m <br /> _ a <br /> m <br /> SPECIAL PERMIT INFO. = a <br /> clotted <br /> Distance to sewer line ce :on <br /> Domestic well on site - _yes/ o = grarelpadc <br /> IP ves, location & distanc - <br /> i <br /> i <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water casing type <br /> � °t. <br /> Mix Ratios 3-2nd Screen `t <br /> Installation thod Slot size <br /> i Bags cement <br /> Quant_,.t Ins` ed <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Dare Permit Finalized <br />