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AGE__) OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> CONSTRUCTION <br /> Premise Address:-27� �✓4S�l�f�� Well No. <br /> Inspector: Total Depth 3 s' <br /> Screen Length <br /> Filter Pack 3S--G <br /> Bentonite Pellets �0 9G <br /> Permit No. 3� Grout 6- <br /> Consultant /7-77 Completion-Stove pip chrlstie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. !f1 <br /> SAMPLING — --- — - <br /> t <br /> Holding Temperature stick-up <br /> Method i O 17If \ <br /> Screening Method <br /> /ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (yQ COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> proof <br /> Storage Method <br /> Contamination Noted ye no <br /> ft. <br /> Storage Location 46 <br /> 104 <br /> = a <br /> SPECIAL PERMIT INFO. _ <br /> � o <br /> aloud velow <br /> Distance to sewer line ction — <br /> Domestic well on site - yes = gravel pack <br /> P <br /> If yes, location & distance -- <br /> ft. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water 5;11 // Casing type 1t16--- <br /> Mix Ratios i S3BlankL,,� ft. Screen ft. <br /> Installation Methocf Slot size • dZ <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel . S <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> �✓w//l�a� Lia� � '-,.,,. <br /> Date Permit Finalized wo -Y01 ►>' ,""'/ <br /> She <br />