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MONITORING WELL INSTALLATION REPORT <br /> Date: /' <br /> / CONSTRUCTION y5e) C' <br /> Premise Addree : H Well No. f� <br /> Inspector: �� Total Depth /90 <br /> screen Length /O£l- <br /> Filter Pack <br /> u- 7 Bentonite Pellets /O 3 - 97 ' <br /> Permit No. /J Grout f7- Sv: si <br /> Consultant Comp» ipn-Stove pipe/christie box <br /> Geologist /K v. 5*.� /� o/ /'`gf!'1 <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding TeM'Per ature stick-up <br /> Method 1411�,e UA�P/i✓4 Y�— <br /> iair/�/ - <br /> 5_7777 -S.Oo a /7 <br /> Screening Method DUf4 <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheat (y ) COMPLETION COMPLETION <br /> SPOILS <br /> Ground Su1�0 + <br /> Oil <br /> Storage Methods/u7'�[ iqf/S <br /> Contamination Noted / o ft. <br /> Storage Location S;Aee �o.1 h. <br /> n. <br /> _ m <br /> M <br /> SPECIAL PERMIT INFO. i <br /> ! <br /> Distance to sewer line /l/ A Blotted _ B <br /> Domestic well on site ye o section = ��� <br /> If yea, location & distance - <br /> fl. = tt. <br /> GROUTING <br /> MATERIALS USED: <br /> S- ' <br /> Depth to water / Z� 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 />