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A / MONITORING WELL INSTALLATION REPORT <br /> Date• -7 7 CONSTRUCTION <br /> Prem'as Address: Well No. N A- <br /> Inspec or: Total Depth <br /> Screen Length �O <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. g - Z 74y Grout ZO <br /> Consultant Completion-Stove pip /christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature <br /> Method <br /> �tickup <br /> Screening Method <br /> Tracking Sheet (y/n) ABOVEGROUND CHRiM-eox <br /> COMPLETION COMPLETION <br /> SPOILS Grourd Sulam <br /> VA <br /> ploul <br /> Storage Method it. <br /> Contamination Noted - yes/no n• <br /> Storage LocationI <br /> aloudSPECIAL PERMIT INFO. .aVonDistance to sewer line <br /> Domestic well on site - yes/no Iy <br /> If yea, location & distance - —n' <br /> GROUTING MATERIALS USED: �7 �L <br /> Depth towater Casing type <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />