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#E_ 0F� ` <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: 4l/ICyln Well NO. /"/ �✓�� <br /> Inspect`oS' : Total Depth <br /> Screen Length <br /> Filter Pack ti S- V '3 <br /> Bentonite Pellets `f0• S _ <br /> Permit No. ! �� Grout yV• 5 �'✓✓ — <br /> Consultant C/ -'u' Completion-Stove. pipe _�istie box <br /> Geologist � Tr q !T 's <br /> Auger O.D. <br /> Auger I.D. y <br /> SAMPLING ------ <br /> Holding Temperature stick-up <br /> Method IffT <br /> MIR <br /> —Tf <br /> Screening Method W-f <br /> ABOVEGROUND CHRISTY•BOX <br /> Tracking Sheet (y COMPLETION <br /> COMPLETION <br /> SPOILS --Ot0ufld Sudan +--- <br /> _,//' prart <br /> Storage Method <br /> Contamination Noted - yes <br /> Storage Locatir9n tt <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> �Jl� slotted <br /> Distance to sewer line sxucn <br /> Domestic well on site - yes no <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to w t r Casing type V G <br /> V <br /> Mix Ratios 9, o.r Blank ft. Screen U ft. <br /> Installation thod Slot size O2 <br /> Quantity Installed Bags cement <br /> % /J' /lo4j Buckets bentonite <br /> / Bags sand/gravel_ <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />