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_ I <br /> 0 <br /> /UC'�� r3 MONITORING WELL INSTALLATION REPORT <br /> Date: Z G CONSTRUCTION <br /> Premise Address: ///G�/J�/� Well No. �/ / 7_ <br /> Inspector: Total Depth 73 <br /> �f. <br /> � Screen Length 73 - 6 ' <br /> Filter Pack 7 3 - 6 G <br /> Bentonite Pallets cG- G',/ <br /> Permit No. O Grout b_/ - / <br /> Consultant 7I Completion-Stove PipCLchristie box <br /> Geologist 'Joe' Gr 4 SP <br /> Auger O.D. d 14-2r <br /> Auger I.D. %vY <br /> SAMPLING <br /> Holding Temperature `c-e-d atkk-up <br /> Method Q/ <br /> Screening Method i <br /> adv CCB/C ABOVE•GRUJND <br /> Tracking Sheet ( n COMPLETION CHRISTY-BOX <br /> COMPLETION <br /> SPOILS Ground Surface <br /> qro� <br /> Storage Method -1" P/ vc <br /> Contamination Noted yes ott. <br /> Storage Location ft. <br /> SPECIAL PERMIT INFO. a <br /> i e <br /> Waited <br /> Distance to sewer line :",• <br /> a.rrion <br /> Domestic well on site - yes/ o <br /> If yes, location 6 distance pack <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water <br /> Casing type L' <br /> Mix Ratios /� Sse Blank �� ft. Screen d'" ft. <br /> Installation Method $lat B1Z$ <br /> ©2 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel 3 <br /> Filter Pack type/size 3 !z <br />