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'AGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> -Date: <br /> f 4 CONSTRUCTION �t <br /> Well No. <br /> Premise Addr s• 3 6t f ) <br /> Inspector:� Total Depth <br /> Screen Length Z <br /> Filter Pack .7_ <br /> Bentonite Pellets jr <br /> Permit No. Grout �20Vd' <br /> Consultant � � �l� _ Completion-Stove pipe Christie ox <br /> Geologist 1JUl o. 14n - <br /> i Auger O.D. <br /> Auger I.D. <br /> SAMPLING 0�41i • -- - ` <br /> stick-up <br /> Holding Te erature <br /> + Method <br /> VY <br /> screening Method <br /> ABpVE•GR0UN0 CHRISTY-BOX <br /> Tracking she (y n) �-. y <br /> GdAAPLEf10N COMPLETION <br /> Gmund Surface <br /> SPOILS <br /> M ' <br /> Storage Method rC, <br /> Contamination Noted -- y no �7 UW5 <br /> Storage Location— <br /> SPECIAL PERMIT INFO. _ o <br /> ' dattad <br /> Distance to sewer line aacrocn <br /> Domestic well on site - yes/no — Braval pads <br /> If yes, location & distance - <br /> GROU"1'ING <br /> �d MATERIALS USED: <br /> r� <br /> Iis Casing type �14� <br /> Depth to water fT0 r <br /> 1 <br /> Blank_ ft. Screen ft. <br /> Mix Ratios <br /> + Slot size <br /> Installation Method Q1D <br /> Quantity Installed Bags cement <br /> f Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br /> f <br />