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• P DF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Well No. <br /> Ins_vector• Total Depth - <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. Grout <br /> Consultant Ccmnletion-Stove pipe/christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> T stick-up <br /> Holding Temperature t <br /> Method N r <br /> Screening Method <br /> ABOVE-GACUND CNAISTY-BOX <br /> Tracking Sheet (y/n) CCNPL�TON cOMPt_RION <br /> Ground Surf acs <br /> 520?LS <br /> grout <br /> Storage Method ft. <br /> Contamination Noted - yes/no h, <br /> Storage Location g• I <br /> _ n <br /> m <br /> SPECIAL PERMIT INFO. = c <br /> slotted = c <br /> Distance to sewer line - sad on <br /> Domestic well on site - yes/no - pavelpack <br /> If yes, location & distance - <br /> i <br /> = <br /> GROUTING <br /> MATERIALS USED: <br /> Denth to water Casing type <br /> °t. `t <br /> Mix Ratios � BlankScreen <br /> Installation Method Slot size <br /> Quantity *installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size- <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />