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• ^kGE_I_OF__ <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: S-19-91 CONSTRUCTION <br /> Premise Addr ss• Ao• Well No. <br /> Inspector: Total <br /> Total Depth -rb ZS <br /> Screen Length 5 1- ('01 <br /> �j' Filter Pack '21 1 _ <br /> Bentonite Pellets l6C 40 <br /> Permit No. Grout <br /> Consultant Completion-Stove, pipe/christie box <br /> Geologist <br /> o.xr C (U G(L Auger O.D. <br /> Auger I.D. Aa <br /> SAMPLING --- - - - --- - <br /> Holding Temperature (AAL $**-up <br /> Method C,9054IM T1 T <br /> Screening Method - u .. <br /> ABOVE-GROUND CHRIS7Y-BOX <br /> Tracking Sheet (yo- <br /> y n) COMPLETION COMPLETION <br /> Ground Surface T•�••••�• <br /> SPOILS <br /> grout <br /> Storage Method <br /> Contamination Noted - yes no ft• <br /> Storage Location E*J Sta-� ft. <br /> = m <br /> _ a <br /> SPECIAL PERMIT INFO. _ <br /> 0 <br /> Wotwd _ c <br /> Distance to sewer line>5-D"cdon <br /> Domestic well on site - yes/60) = Pack <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water (l f'1 Casing type PYe. <br /> Mix Ratios BlankJ-1� _ ft. Screen IS ft. <br /> Installation Method Slot size .02 <br /> Quantity Installed Bags cement <br /> Buckets entonite <br /> Bags an /gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />