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MONITORING WELL INSTALLATION REPORT <br /> Date: . - CONSTRUCTION <br /> M <br /> e Address: well No. "04 <br /> Inspector• Total Depth <br /> • LS7l Screen Length 50 <br /> Filter Pack %• -�"2,� <br /> /?� _ O1 Bentonite Pellets Z <br /> Permit No. `4 Grout <br /> Consultant completion-Stovee/christielox <br /> Geologist '. <br /> Auger O.D. ZS <br /> Auger I.D. <br /> SAMPLINC3 <br /> 0 <br /> Holding Temperature C, <br /> Method akvc <br /> Screening 2eXd <br /> • <br /> Tracking Sheet y n) ABOVE-►IauniD <br /> GObtPLETYJH crwaslY-hox <br /> SPOILS <br /> C0fiWLETION <br /> � CiiwrdSirTr� <br /> Storage Method I <br /> Contamination Noted - yes <br /> Storage Loratian n, <br /> Id <br /> 0 <br /> uo1wd — <br /> SPECIAL PERMIT.' INFO - <br /> warw pack 'a <br /> Distance to sewer line—> -_ <br /> Domestic well on Bite - yes <br /> if yes, location & distance - n. - �• <br /> GROUTING MATERIALS USED: <br /> Depth to water $ Casing type '-6V(1_1 <br /> Mix RationBlank &jft. Screen S1 ft. <br /> Installatioon Method �fl��` Slot size <br /> Quantity I,natalled Bags cement <br /> Buckets bentonite i <br /> Bags sand/gravel <br /> Filter Pack type/size <br />