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AGE 2> OF_ ZL_ <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: ?.� �l �I '(�/ CONSTRUCTION <br /> Premise Addre's's &4-0- <br /> ,• IV Well No. 444 <br /> Inspector• Total Depth <br /> Screen Length 21. <br /> {3'53 Filter Pack <br /> Bentonite <br /> Permit No. Grout <br /> Consultant Completion-Stove pipe/christie box <br /> Geologist <br /> Auger O.D. �� <br /> Auger I.D. (� <br /> SAMPLING - <br /> Holding Temperature stick-up <br /> Method <br /> Screening Method •_ T <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/0 COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> proof <br /> Storage Method <br /> Contamination Noted - y?p no ft' <br /> Stora a Loca ion <br /> _ m <br /> SPECIAL PERMIT INFO. <br /> o <br /> slotted <br /> Distance to sewer line->6--Dsection -' <br /> Domestic well on site - yes/ o _ gravel pack <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> 1� <br /> Depth to water Casing t pe k- <br /> Mix Ratios Blank_ ft. Screen ft. <br /> Installation Method Slot size .01• <br /> Quantity Installed Bags cement _ <br /> Buckets bentonite <br /> Bags sand/gravel 09 <br /> Filter Pack type/ ize <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />