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OGE 3 OP` <br />MONITORING WELL INSTALLATION REPORT <br />Date:�� a 2-19 m <br />Premise Address: &- ,J4ft&L <br />Inspector: Arve, <br />Permit No. 912 - 2-&'7' <br />Consultant <br />Geologist <br />Holding Te Brat <br />Method NIZ <br />Screeni <br />Trac�ving Sheet (y/n) <br />SPOILS <br />Storage Method <br />contamination Noted - yes/no <br />Storage Location <br />SPEgTAL PERMIT INFO-. <br />Distance t s er line <br />Domesticw Site - yes/no <br />If yes, cation istance <br />GROUTING <br />Depth to water <br />Mix Ratios /,A <br />Installation Method t <br />Quantity Installed <br />Total Billed Time Per Site <br />Date Permit Finalized <br />Well No. <br />Total Depth <br />Screen Length .2a® <br />Filter Pack <br />Bentonite Pellets �f <br />Grout <br />Completion -Stove pi a/christie box <br />Auger O.D.--�-®� <br />Auger I.D. ® Yom` v� <br />MATERIALS USED: <br />Casing type -?ilsc-4 - o <br />Blank__Ll ft. Screen 20 ft. <br />Slot size P®2®® <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />