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• �GE S 0F_Z0 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date:- CONSTRUCTION///U / <br /> Premise Address: L1A(U/ ��/�fC Well No. �W' <br /> Inspector• Total Depth 7� <br /> �t Screen Length 7�- <br /> Filter Pack <br /> �!Q <br /> Permit No. �G7�� � Bentonite Pellets �/ • 9 S 6• S' <br /> � .�/�• Grout <br /> Consultant_ Completion-Stove pipe <br /> Geologist �_ .c-� /ji(/�/dc✓ <br /> Auger O.D. / <br /> Auger I.D. fl <br /> SAMPLING <br /> Holding Tempe ature f u� stick-up <br /> Method �'n/✓7i/vOv3 to it T <br /> Screening Method T <br /> ABOVE-GROUND CHRISTY•BOX <br /> Tracking Sheet (y n COMPLETION COMPLETION <br /> SPOILS G=nd S <br /> //�J <br /> praul <br /> Storage Method 6AX%-/s <br /> Contamination Noted - ye no �-n• <br /> Storage Locatign tt• <br /> SPECIAL PERMIT INFO. <br /> C slotted <br /> Distance to sewer line <br /> secyos 8 <br /> Domestic well on site - yeno <br /> If yes, loca igra�w pack <br /> on & istance - J __ <br /> n. = n. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water �G� S Casing type SZei° / <br /> Mix Ratios Blank_ ft. Screen 2c-) ft. <br /> Installation Method Slot size •0.Z S <br /> Quantity Installed Bags cement <br /> Buckets bentonite /. S <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />