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N<b- MONITORING WELL INSTALLATION REPORT <br /> Date�l �i� <br /> , CONSTRUCTION <br /> Premise Address: r )PU Well No._ N,4 -y <br /> Inspector• Total Depth %Y� <br /> Screen Length/ <br /> Filter Pack_&/,�C y� <br /> � � Bentonite pellets S� <br /> Permit No. /� Grout l6� <br /> Consultant <br /> Geologist completion-Stove pipe/christie box <br /> Auger O.D <br /> SAMPLING <br /> Auger I.D. <br /> ��� <br /> Holding Temperature <br /> Method <br /> �rtlrkup <br /> Screening Method <br /> Tracking Sheet (y/n) <br /> MovEi:NOUNU <br /> G04WlE:lON CNflim box <br /> SPOILS <br /> [anp4EiioN <br /> Gourd Sui.q <br /> Storage Mgthod /?,A/per <br /> Contamination Noted - yes/no GS/ n. <br /> Storage Location /n., n,On �t n. _ n• <br /> SPECIAL PERMIT INFO Wawa <br /> Distance to sewer line p..d Pa <br /> 2 �.,d <br /> Domestic well on site - yea/no <br /> If yea, logation S distance <br /> I fG' <br /> 6� <br /> GROUTING <br /> MATERIALS USEDDs <br /> Depth to Wgter ^ Casing t pe, r:� <br /> Hix Ratios 2_ - / +.w_ oz r��/qac., Blank'_ ft. Screen <br /> InstallatLpn Method < V /0 ft. <br /> Slot size 1111), <br /> Quantity ID4talled <br /> Bags cement �S a-cam <br /> Buckets bentonite <br /> Bags sand/gravel qS T_ <br /> Filter Pack type/size s.h�� <br />