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MONITORING WELL INSTALLATION REPORT <br /> Data: U CONSTRUCTION <br /> Premise Address: ��✓ Well No. 'Ll') S <br /> Inspectors Total Depth <br /> Screen Length In <br /> Filter Pack GwnL <br /> Permit Nn. e/-2L1L <br /> Bentonite Pellets__i' <br /> Grout(4&,,,A <br /> .., A <br /> Geologist <br /> Consultant completion-Stove pipe/christie box <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING /,J/,l <br /> Holding Temperature <br /> Method <br /> Screening Method --�� <br /> Tracking Sheet (y/n) <br /> AUOVE-0II0LIND <br /> 0DWLE JON D1f lsTY Dox <br /> SPOILS GOMKETION <br /> OmIW but�q 7 <br /> Storage Mqthod_KAj. 910A <br /> Contamination Noted - yes/no 7 <br /> Storage Lpcation_,_il� L D. _ n' <br /> SPECIAL PFJRMIT INFO Woud <br /> 9 qpY <br /> Distance to sewer line/l ' <br /> Domestic well on site <br /> If yea, location 6 distance <br /> n. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water / Cavin <br /> Mix Ratios / g tYPe <br /> Blank_ ft. Screen�b _f t. <br /> Inetallatlgss Method . �,,,.u. / Slot size <br /> Quantity IDgtalled Bags cement <br /> Buckets bentonite. '7/<c_i, <br /> Bags sand/gravel (� , ' -- <br /> Filter Pack type/size 6 yl�_, I i, <br />