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• . &GE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: I' ` � `� CONSTRUCTION <br /> Premise Address: 2a�Q0 Well No. �C., <br /> Inspector• Total Depth <br /> Screen Length <br /> Filter Pack �0 <br /> Bentonite Pellets 33 ` .S <br /> Permit No. Grout <br /> Consultant L. Completion-Stove pip Christiebox <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. / <br /> SAMPLING 1�0/ Uvti' <br /> Holding Temperature <br /> Method 4f Aj <br /> Screening Method 6 L <br /> ABOVE-GROUND <br /> Tracking Sheet n) COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> grout <br /> Storage Method <br /> Contamination Noted - yes/no ft. <br /> Storage Location ....__.ft. <br /> V <br /> = a <br /> SPECIAL PERMIT INFO. __ o <br /> slotted _ c <br /> Distance to sewer line -25o <br /> taction = <br /> Domestic well on site - yes/no gravWpack <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water 3.�j Casing type <br /> Mix Ratios Blank__foD ft. Screen Z ft. <br /> Installation Method Slot size „ \ <br /> Quantity Installed Bags cement i'3_WLV (�^",•tY� <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size. 3 <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />