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MONITORXXG WELL INSTALLATION REPORT <br /> Date. 1 � CONSTRUCTION <br /> Premise Address: !j Well No. <br /> Inspector l t� Total Depth S <br /> Screen Length Z5 7 Z 5 <br /> Filter Pack •s- <br /> Z� <br /> BentonitePellets `Z� <br /> Permit No. 0 Grout �r <br /> Consultant Completion-Stove pip christie box <br /> Geologist 1 <br /> Auger O.D. <br /> Auger I.D._�2. z . <br /> SAMPLING _ --- - -- <br /> Holding Temperature 6C- stldc'up <br /> Method <br /> Screening Method <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/ ) COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> grout <br /> Storage Method ' PfAV-t.y <br /> Contamination Noted - yespz <br /> �ft• <br /> Storage Location n• <br /> it. <br /> SPECIAL PERMIT INFO. <br /> � e <br /> slo tad <br /> Distance to sewer line— <br /> on <br /> Domestic well on Bite - yes �� <br /> If yes, location & distance - <br /> _.....,.ft. it. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water. Casing ty9e ( - °YtJ Yv <br /> Mix Ratios 1✓ Blank—I— ft. Screen 9 ft. <br /> Installation Method k (�� Slot size <br /> Quantity Installed Hage cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />