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PAG -,, OF <br /> MONITORING 'HEELL INSTA�TION REPORT <br /> Date: a Z l� CONSTRUCTION <br /> Premise add.a s: <br /> Well No. tZ <br /> Inspector: Total De_th I v' 4 sy <br /> Screen Length_ 1L), 16v ' 10�-> - <br /> Filter Pack tic, - °1 $ <br /> 3entonite Pellets 19 - nl <br /> Permit No. Grout � j o <br /> consultant Ir= Completion-Stove pipe/christie box <br /> Geoloci st ll <br /> prt LL-e - ( S ;,-,, "`y k - Auger O.D. <br /> �N <br /> auger I.D. <br /> SAMPLING <br /> �- -sticdc up <br /> Folding Temperature - <br /> T <br /> Method . v <br /> Screening Methcd-4Tl7 <br /> ABCVE-Gpc'JND C-HRisTY-30X I <br /> Tracking Sheet ®/n) �T,CN COMP, <br /> i <br /> GrOUIn;Sta!ac <br /> SPOILS <br /> grout <br /> Storage Method 1���frV` e, <br /> Contamination :Toted - v ' C <br /> Storace Location .�51 It ,,o ti <br /> a 72 <br /> m <br /> m I <br /> SPECIAL, PERMIT INFO. = <br /> o <br /> alcred — c <br /> Distance to sewer line a� on <br /> Dcmestic well on site - ves/no <br /> If ves, location & distance - <br /> � I _ ft. <br /> GROUTING <br /> MATERIALS USED: <br /> Dept: to water T,$ Casing type - p V L <br /> M_:c Ratios 04,*w - Blank — reen <br /> _nstal'_a=ion Method ]r" ,AAf-t Slot size •caw LL <br /> —ar -- _nstalled Sacs cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> . -_ter Pact type/size b 3 <br /> Total Billed Time Per Site <br /> Da Permit Final'-zed <br /> 7- 2Z- c � AJALJ- 1Z <br />