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• WAGE— Y OF I/0 <br /> MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Premise Address: &/1C0/17 L/,' '• Well No. (�.� <br /> Inspector• Total Depth <br /> �1 Screen Length - Sc7 <br /> Filter Pack - �- <br /> No. U-�(�a 7 �7� Bentonite Pellets <br /> Permit <br /> Grout G <br /> Consultants SG // /<, ter/ Completion-Stove. pipe Christie box <br /> Geologist_�4/ / _. <br /> Auger O.D. <br /> SAMPLING <br /> Auger I.D. G <br /> W <br /> Holding Temperature $ ++P <br /> Method-'S pL I <br /> Screening Method v <br /> ABOVE-GROUND CHRIS7Y-BOX <br /> Tracking Sheet ( n COMPLETbN <br /> COMPLETION <br /> SPOILS G=nd Sulaco T� <br /> Storage Method /v S proul <br /> Contamination Noted - es nof►. <br /> Storage Location o g, <br /> a <br /> SPECIAL PERMIT INFO. = z <br /> Distance to sewer line SSU sI°n <br /> Domestic wellon site - yes/fid sacGon <br /> If yes, location & distance - 7ra"°Ipack <br /> GROUTING <br /> MATERIALS USED: <br /> ' r <br /> Depth to water Casing type <br /> Mix Ratios 1/(0 Blank SCS ft. Screen Z� ft. <br /> Installation Method Slot size , C) -L <br /> Quantity Installed Bags cement T _ <br /> Buckets bentonite <br /> Bags sand/gravel �3 <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized 1614CA c/ MlOq <br />