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• PW—L—OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: 7/ CONSTRUCTION <br /> _ Premise Address: 3 5 -,�(�CiU Well No. �!�/G✓ 2- -� <br /> Inspector: 4 f/� Total Depth <br /> Screen Length <br /> Filter Pack 3 2 "7 <br /> Bentonite Pellets <br /> Permit No. - Grout �a ' <br /> Consultant Completion-Stove pip _christie box <br /> Geologist �'� - ��� <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> gldc up <br /> Holding Temperature <br /> Method T <br /> T <br /> Screening Method V .- <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) coi"PLETION COMPLETIONli <br /> - -C3rcund Surface <br /> SPOILS grout <br /> Storage Method <br /> Contamination Noted - Ve /no ft. <br /> Storage Location ft, <br /> a <br /> _ m <br /> SPECIAL PERMIT INFO. = c <br /> slotted — c <br /> Distance to sewer line SU wcdon <br /> Domestic well on site - yes/7n = yravelpadc <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water � � Casing type C <br /> Mix Ratios Blank ft. Screen Z ft. <br /> Installation Method Slot size CMZ <br /> Quantity Installed Bags cement <br /> Buckets bentonite / <br /> Bags sand/gravel 3 <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />