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?AGE__�_OF_ <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address! Well No. t'( 7 / <br /> Inspector: Total Depth aU <br /> Screen Length 0-/U <br /> Filter Pack ZU - <br /> Bentonite Pellets 7 <br /> Permit No.O Grout - <br /> Consultant Completion-Stove pip hristie bo <br /> Geologist / r e <br /> 0 as <br /> Auger 0.D. <br /> Auger I.D. <br /> SAMPLING — -- <br /> Holding Temperature <br /> stick-up <br /> Method <br /> Screening Method <br /> AE&E-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) COMPLETION <br /> COMPLETION <br /> Ground Surlacs <br /> SPOILS <br /> ��// grout <br /> Storage MethodC <br /> Contamination Noted - yes o <br /> Storage Location n' <br /> = a <br /> SPECIAL PERMIT INFO. '- <br /> loded <br /> Distance to sewer line awaion <br /> Domestic well on site - yes/ _ 9nkVWPack <br /> If yes, location & distance - <br /> ft. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water !�' �/Casing ty e c <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel t/ <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />