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AML <br />MONITORING WELL INSTALLATION REPORT <br />Date: <br />Premise Address: F*/� Fr <br />Inspectors <br />Permit No. <br />Consultant gfe';' a <br />Geologist <br />SAMPLING <br />ifolding',q,emperat <br />Method <br />Screening thod <br />Traciding Sheet (y/n) <br />SPOILS <br />Storage Method <br />Contamination Noted es/ -no <br />Storage Location Zd'61fd",d <br />SP IAL PERMIT INFO. <br />P <br />Distance sewer e <br />site Domestic wel - yes/no <br />If yes, loc a an distance <br />GROUTING <br />Depth to water el <br />Hix Ratios /s, ,n,,f Z -7 ,?/s Y <br />installation Method <br />Quantity Installed <br />Total Billed time Per Site <br />hate Permit Finalized <br />CONSTRUCTION <br />Well No. HU) - 1,6 <br />Total Depth <br />F7 <br />Screen Length <br />2-40 <br />Filter Pack <br />Bentonite Pellets <br />Grout <br />60 <br />Completion -Stove pippTchriatie box <br />Auger O.D. to <br />Auger I.D. _71& <br />Tatk*-Up <br />—W—f <br />A"E-GROUND CHRISTY-BOX <br />COWPLET1ON COMPLETION <br />otound Swisce - f <br />9(out <br />slotted <br />**c4on <br />9mvel pack <br />4 <br />MATERIALS USED: <br />Caning type QVC JnCL - 1/C) <br />4e Blank 607 f t . Screen_g2.j ft. <br />Ylfk'slot size _®2 <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />