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MONITORING WELL INSTALLATION REPORT <br /> Date: 7 CONSTRUCTION <br /> Prem•as Address: Well No. 14,9 - 1 <br /> M�o--•s e.., <br /> InspBctor: �/�.J ' g Total Depth <br /> • r�`� ���S Screen Length <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. Grout 9101-1117- <br /> Consultant Completion-Stov"e pipe/christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature <br /> Method <br /> �tickup <br /> Screening Method 1. <br /> Tracking Sheet (y/n) ABOVEGROUND CHMSMBOX <br /> COWLEY" COMPLETION <br /> SPOILS Gmuld"+fir• <br /> ploul <br /> Storage Method <br /> Contamination Noted - yes/no y n• <br /> Storage Location Win• — <br /> S <br /> NOW <br /> SPECIAL PERMIT INFO. cul <br /> W&W pst <br /> Distance to sewer line LE <br /> Domestic well on site - yes/no <br /> If yes, location & distance - —B• n• <br /> GROUTING MATERIALS USED: <br /> Depth to water 3 Casing type Q <br /> Mix Ratios '4ad Blank ft. Screen ft. <br /> Installation Method -^L? Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />