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AGF OF <br />4 <br />MONITORING WELL INSTALLATION REPORT <br />Date: ✓ /� l `� <br />Premise Address : // <br />Inspector: , f 7/ <br />Permit No. <br />Consultant <br />Geologist <br />SAMPLING <br />Holding Temperature V <br />Method <br />Screening Method <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/no <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. <br />Total Depth <br />Screen Length <br />Filter Pack ;SCJ <br />Bentonite Pellets :5! �. <br />Grout <br />Completion -Stove pip Christie box <br />Auger O.D. i <br />Auger I.D. <br />II = I T stick-up <br />ABOVE -GROUND CHRISTYWX <br />COMPLETION COMPLETION <br />Ground Surface <br />grout <br />T ft. <br />ft. <br />C <br />o <br />slotted = c <br />section <br />gravel Pads <br />MATERIALS USED: <br />Casing type <br />Blank ft. Screen ft. <br />Slot size <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />