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- _ pE__L'_OF i <br /> MONITORING WELL INSTAIIATION REPORT <br /> Date: r ONST ILUCTION <br /> Premise Address: ys 'r' Is <br /> ell No. 7 <br /> Inspector: - otal Depth <br /> creep Length .2 3 ` <br /> ilter pack - 7O <br /> entonite Pellets �� _ 7 <br /> Permit No. _ JS Z, rout - 7- <br /> 'Consiiltant " ✓ ow Completion-stove. pip christie box <br /> Geologist <br /> Luger O.D. <br /> uger I.D. <br /> SAMPLING �} " <br /> Cj4('J slkiaup <br /> Holding Tem e ature <br /> Method <br /> Screening Method <br /> YE-GROUND CHWM-BOX <br /> Tracking Sheet (y n COMPLETION COMPLETION <br /> Ground Surlaca <br /> SPOILS / grout <br /> w / �i' ��p c�ir�.�Y•a.cJ <br /> Storage Method SO- y3 c <br /> Contamination Noted - yes <br /> Storage Locatign <br /> . o <br /> t SPECIAL PERMIT INFO. _ o <br /> k "j7 stDtWd <br /> Distance to sewer line secd°^ <br /> W pack <br /> Domestic well on site - ye /nA 9M <br /> If yes, location & distance <br /> � r <br /> GROUTI NG <br /> MATERIALS-USED:- <br /> Depth <br /> ATERIALSUSED•Depth to water Casing type <br /> Blank? ft. Screen 2 ft. <br /> Mix Ratios .. <br /> Slot size <br /> Installation Method <br /> Quantity Installed Bags cement - S <br /> uckets bentonite <br /> ags sand/gravel 7 j <br /> Filter Pack type/size `/Z <br /> Total Billed Time Per Site > _O <br /> Date Permit Finalized <br />