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MONITORING WELL INSTALLATION REPORT <br /> Datei d CONSTRUCTION <br /> Premise Addresslao r?� Well No. 1UR- <br /> Inspectors n-<- t Total Depth ! C <br /> Screen Length In <br /> Filter Pack -r -Z <br /> Bentonite pallets <br /> Permit No.�; (.- iii, crout�o <br /> Consultant <br /> Geologist completion-Stove pipe/christie box <br /> Auger O.D. <br /> / <br /> SAMPLINAuger I.D. <br /> G iii/,,t--, <br /> Holding Temperature <br /> Method <br /> �•tldtup <br /> screening Method i <br /> Tracking Sheet (y/n) <br /> Above-snouND <br /> COWLETON DOM box <br /> SPOILSCOMKETbon <br /> omw s nr.7 . <br /> Storage Mgthod LLZ -' /�- <br /> Contamination Noted - yes/no ins sss111n• <br /> Storage Lgcation -tr'sl�. _ I ^ n• <br /> SPECIAL PERMIT INFO u01WO = ` <br /> ••cuwb — S <br /> g A P•db <br /> Distance to sewer line/ <br /> Domestic well on site - yes/no <br /> If yes, location & distance <br /> IZI� <br /> 13s <br /> GROUTING <br /> MATERIALS USED: <br /> ( / <br /> Depth to water Casing typ <br /> Mix Ratios � „ �a Blank S_, f Screen ie) ft. <br /> Installatlgn Method Slot size <br /> Quantity I4ptallad Bags cement <br /> Buckets bentonite.7 <br /> Bags sand/gravel YCiT, c� <br /> Filter Pack type/size ,1/WA/L- <br />