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MONITORING WELL INSTALLATION REPORT f <br /> 3 <br /> Date: CONSTRUCTION <br /> L / <br /> Premise Address: Well leo• �✓ 2� <br /> Inspector• Total Depth d <br /> Screen Length 3• S ��' <br /> Filter Pack, 4c2 <br /> Bentonite Pellets ao G <br /> Permit No. Z L/ Grout S <br /> Consultant L Complet' i�-stoi�e jipg,12hristie .box <br /> i <br /> Geologist C rid <br /> Auger-O.D. i <br /> Auger I.D. <br /> SAMPLING <br /> stilt-up j <br /> Holding Temperature <br /> Method <br /> Screening Method - <br /> I18oVi=-GRDc]ND CHRiSiY-BOX <br /> Tracking Sheet (yen)'_ CoWPLEfION COMPLETION <br /> Ground Surface <br /> SPOILS grout <br /> Storage Method ��d�Sft• <br /> Contamination Noted - yes/ fl. <br /> Storage L cation <br /> � f <br /> SPECIAL, PERMIT INFO. _ o <br /> slatted <br /> Distance to sewer line a °n. r <br /> .m• _ it <br /> Domestic well on site - yesCho l,; " �iark <br /> If yes, location & distance <br /> GROUTING <br /> . MATERIALS .`USED• <br /> Casing type. G' <br /> Depth to water_ Z ft. <br /> ' Mix Ratios Blank ft. Screen,. <br /> Installation Method <br /> Slot size <br /> Quantity Installed Bags cement a <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />