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l MONITORING WELL INSTALLATION REPORT <br /> 7 <br /> Date: L� CONSTRUCTION <br /> Premise Address:?7�� �� �'� Well No. <br /> Inspector: _ Total Depth <br /> Screen Length <br /> Filter Pack #'? <br /> c/ Bentonite Pellets <br /> Grout C <br /> Permit No. _ P--t-1I - <br /> ConsultantCompletion-Stove pipe christie_bax <br /> -- - <br /> Geo logi st-6,L-A AL11 <br /> E Auger O.D <br /> 77 <br /> Auger 1.D . <br /> SAMPLING <br /> a� <br />. Holding Tem erature stk*-up <br /> Method <br /> Screening Method PM ,. <br /> ABOVE-GROUND CHHISTY-BOX <br /> Tracking Sheet �n) COMPLETION COMPLETION <br /> Ground Surtwe <br /> SPOILS <br /> proof <br /> Storage Method /� � t <br /> Contamination Noted - ye /no _ Z <br /> Storage Location/� -✓ <br /> 0 <br /> SPECIAL PERMIT INFO. — c <br />- o <br /> stoned c <br /> Distance to sewer line section _ <br /> Domestic well on site - yes no <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing t e � Zr _ <br /> Mix Ratios .c-a Blank 2 ft. Screen 7_.5 ft. <br /> Installation Method Slot size •G'Z-C? <br /> Quantity Installed 4- ? Bags cement- "- < <br /> Buckets bentonite v <br /> Bags sand/gravel J� <br /> Filter Pack type/size A3 <br /> Total Billed Time Per Site <br /> Date Permit Finalized !] <br />