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MONITORING WELL INSTALLATION REPORT <br /> Date: /f XXIf�C3 <br /> CONSTRUCTION <br /> Premise Addres : //o W ,i,1 well No.TZ <br /> Inspector: �� Total Depth VV <br /> Screen Length Itr <br /> Filter Pack Sir(73 <br /> Bentonite Pellets lS <br /> Permit No. Grout <br /> Geologist dQnn <br /> Consultant �: Completion-Stove pipeQchristie bo. <br /> Auger O.D. <br /> SAMPLING Auger I.D. <br /> Holding Temperature <br /> Method <br /> Screening Method 1 <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet { n) COMPLETION COMPLETION <br /> SPOILS G"XNd Sudwe <br /> Storage Method L �� <br /> Contamination Nate - yes/no n• <br /> Storage Location <br /> w <br /> SPECIAL PERMIT INFO. <br /> c <br /> 8101W <br /> Distance to sewer line � cn <br /> Domestic well on site - e /no <br /> if yes, location & dista ce : QMVGI pa(* <br /> GROUTING �I f <br /> MATERIALS USED:1 � (,f <br /> Depth to water Casing type A/(,' f y <br /> Mix Ratios Cln,. -� Blank ft. Screen-- lop �ft. <br /> Installation Method I. `tom Slot size X a O <br /> Quantity Installed <JI"4 Bags cement 1S i <br /> Buckets bentonite <br /> Bags san gravel <br /> Filter-Pack type/size U " <br />