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OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: /4 �/G'- /G, CONSTRUCTION <br /> Premise Address: �y� �/''�� well No. <br /> Inspector; Total Depth c1f- <br /> / Screen Length 5 C'• - G� <br /> Filter Pack <br /> �j Bentonite Pellets 6 <br /> 5S. / S <br /> Permit No. ,ra�L� �� p Grouts Y 1 <br /> Consultant f / Complet' n-Stove pipe hristie box <br /> Geologist 6:� 1-7 <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Z&*-UP <br /> Holding Temperature <br /> Method CWT <br /> Screening Method .� <br /> ABOVE-GROUND CHRISTY-Box <br /> Tracking Sheet (y/n) ODM?LETION COMPLETION <br /> Ground Swtacs <br /> SPOILS Orc A <br /> Storage Method_ J, �ft. <br /> Contamination Noted - yes no <br /> Storage Location <br /> 5 <br /> SPECIAL PERMIT INFO. o <br /> /% section <br /> Distance to sewer line - <br /> Domestic well on site - yes/ w pravelPack <br /> if yes, location & distance - <br /> GROUTING <br /> MATERIALS USED,' <br /> F-0 el <br /> Depth to water Casing type <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method <br /> Slat size G `� <br /> Quantity Installed Bags cement <br /> Buckets bentonite r <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> TotalBilled Time Per Site 11 <br /> Date Permit Finalized L- go ��� <br />