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1 <br />AGB OF <br />r <br />MONITORING WELL INSTALLATION REPORT <br />Date: <br />Premise Address:����� <br />Inspector• <br />Permit No. <br />Consultant /0�� <br />Geologist <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Metho <br />Tracking Sheet (y/n) <br />SPOILS <br />Storage Method <br />Contamination Noted - yes/no <br />Storage Location <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - yes/ <br />If yes, location & distance - <br />GROUTING <br />Depth to water <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />Total Billed Time Per Site <br />Date Permit Finalized <br />CONSTRUCTION <br />Well No. Ll"/ <br />Total Depth 7 <br />Screen Length <br />Filter Pack <br />Bentonite Pellets_/% - �- <br />Grout <br />Completion -Stove pa/christie box <br />' <br />Auger O.D. <br />Auger I.D. �/ 7 <br />stldc-up <br />T <br />ABOVE -GROUND CHRISTY-BOX <br />COMPLETION COMPLETION <br />Ground Sumacs <br />grout <br />ft. <br />-- m <br />C <br />o <br />slotted = c <br />vection <br />gravel pack <br />IVft. <br />MATERIALS USED: <br />Casing type <br />Blank %_ ft. Screen ft. <br />Slot sizey <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />