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62AGE__� _OF� <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: � Z s/�U CONSTRUCTION <br /> Premise Address: `,IACDll V11/Z; Well No. <br /> Inspect <br /> �:_ Total Depth //7 <br /> Screen Length - <br /> Filter Pack <br /> G ZOZ7 Bentonite Pellets_ 9y-f0 <br /> Permit No. � Grout <br /> Consultant ' S / 7f7 Completion-Stove pip christiebo <br /> Geologist <br /> Auge v ,moo <br /> yc}efI.-D D. <br /> SAMPLING --- ---- - - <br /> Holding Temperature <br /> stick-up <br /> Method <br /> Screening Method T <br /> ABOVE-GROUND CHRISTY•BOX <br /> Tracking Sheet (y/n) COMPLETION <br /> COMPLETION <br /> SPOILS -- SuAaci 7 — <br /> OfloUt <br /> Storage Method (/ <br /> Contamination Noted - yes/no roft <br /> Storage Locat ion? ft <br /> v <br /> n <br /> m <br /> SPECIAL PERMIT INFO. _ � <br /> o <br /> Distance to sewer line S sibktion = $ <br /> Domestic well on site - yes/� _ gravilPvk <br /> If yes, ,l�o/cation & distan e <br /> 7 lieo,. / yG�� —_ <br /> 3 So <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type s)ec- <br /> Mix Ratios Blank_L-�_ ft. Screen ft. <br /> Installation Method Slot size , 0.2S <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site �\ <br /> Date Permit Finalized <br />