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. WAGE � OF� <br /> MONITORING WELL INSTALLATION REPORT <br /> / 0111C, 5 <br /> �� // CONSTRUCTION <br /> . <br /> Premise Address: r1C01,7 Vr' 1[G5 L_ Well No. <br /> Inspector: Total Depth <br /> Screen Length So ' <br /> Filter Pack `7t'2 - �/$ ,7 <br /> Bentonite Pellets !PL7— /7. 2 <br /> Permit No. Grout . Z ' <br /> Consultant LeeC44/// Completion-Stove pip christiebox <br /> Geologist <br /> Auger O.D. <br /> Auger Z.D. <br /> SAMPLING <br /> Holding Temperature <br /> rrtldc-up <br /> Method <br /> Screening Method <br /> ABOVE-GROUNO CHRISTY-BOX <br /> Tracking Sheet (y6n COMPLETION COMPLETION <br /> SPOILS --Ground SuAace + __ <br /> / ZR prloul <br /> Storage Method <br /> Contamination Noted - yes/no <br /> Storage Loc tion .0V7 5-, re-' n' <br /> �Tx1 AS n. = <br /> _ <br /> = m <br /> SPECIAL PERMIT INFO. <br /> o <br /> Distance to sewer line dotted toctoa = <br /> Domestic well on site - yes/� _ �vP� <br /> If ea, loca ion & di tance <br /> ✓e/%OS� G-�G��- 3Sc7 <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water S-S 5 2' 8 Casing typetOVG <br /> Mix Ratios Blank 4Z ft. Screen z ft. <br /> Installation Method Slot size .02- <br /> Quantity <br /> O2Quantity Installed Bags cement <br /> ��� t6�d Buckets bentonite <br /> .A Bags sand/gravel <br /> ms 's"z Filter Pack type/size ,4-' ? <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />