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MONITORING WELL INSTALLATION REPORT <br /> Date: iLf IS /d pp 1 / M CONSTRUCTION <br /> Premise Addree : �. /[-o l iL /C,•/ Well No. N/ C - L <br /> Inspector: Total Depth/7'lji <br /> Screen Lengt <br /> Filter Pack 1U�.1LL S <br /> BentoniteJJPellets <br /> Permit No.�,Z-u 1� Grout't j mit (1"..A l Sk <br /> Consultant T Completion-Stove pipe/christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. V � . C� N <br /> SAMPLING " <br /> Holding Temperature ° �L <br /> Method <br /> Screening Method <br /> ABOVE-GROUND CHRISTY•BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> 6rourd Sutace <br /> SPOILS <br /> proal <br /> Storage Method /�nl�'+i�G _ )"�UJG 3 D <br /> contamination Noted - yes no Q n' <br /> Storage Location <br /> s <br /> e <br /> SPECIAL PERMIT INFO. <br /> sloltsd = S <br /> Distance to sewer line i)/,..0 sicyort <br /> Domestic well on site - y'eB/no <br /> If yes, location & distance - <br /> WaW pack <br /> GROUTING �I . <br /> MATERIALS USE <br /> Depth to water .36/ 13 Casing type &t <br /> Mix Ratios 2-1jo/� Blank__'' ft. Screen 16' ft. <br /> Installation Method - �.'-'^,'J`--'d' Slot size Jfb <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size X <br />