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1E OF <br /> MONITORING WELL INSTALLATION REPORT <br /> C <br /> Date• CONSTRUCTION �yJ / / <br /> Premise Address:�7�D L✓a�/J�il l'a� Well No. //'/ <br /> Inspector: Total Depth 7�! <br /> Screen Length <br /> Filter Pack 7?l' r _5_1_757 5- <br /> Bentonite Pellets <br /> Permit No. Z l� Grout �7 , <br /> Consultant Completion-Stove pip Christie box / <br /> Geologist <br /> Auger O.D. ✓� <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature stick-up <br /> Method <br /> Screening Method ._ <br /> ABOVE-GROUND <br /> Tracking Sheet COMPLETION CHRISTY-BOX <br /> COMPLETION <br /> Ground Surface <br /> SPOILS <br /> proof <br /> Storage Method �S <br /> Contamination Noted - yes o ft' <br /> Storage Location ft' <br /> _ <br /> _ m <br /> = a <br /> SPECIAL PERMIT INFO. _ <br /> r <br /> slotted <br /> Distance to sewer line ///��L seclion <br /> Domestic well on site - yes/ o _ gravel pack <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing tye <br /> Mix Ratios Blank C ft. Screen r _ft. <br /> Installation Method Slot size + UZ- <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size '3 <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />