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MONITORING WELL INSTALLATION REPORT <br /> Date:- lUl'j�//'1 V CONSTRUCTION <br /> Premise Address: ""N 4 Well No. <br /> Inspector: Total Depth <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets Q <br /> Permit No. " Grout 53O <br /> Consultant Completion-Stove pipe Christie box <br /> Geologist S(►(�� <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temp rature •tkk�p <br /> Method- 1SCk_1 L <br /> Screening Methoo i r <br /> ase ABOVE-GROUND CHRISIY-BOX <br /> Tracking Sheet 0n) COMPLETION <br /> v COMPLETION <br /> SPOILS GroundStalace <br /> n 12proal <br /> qq <br /> Storage Method j!4Qu4M� <br /> Contamination Noted - ye no% �• <br /> Storage Locat�-i���n,' _ tt• <br /> ,n <br /> SPECIAL PERMIT INFO. _ <br /> c <br /> sloitod <br /> Distance to sewer line Nction <br /> Domestic well on site - yes no - gr&vW P <br /> ack <br /> If yes, location & distance '- <br /> tt. — ft. <br /> GROUTING <br /> MATERIALS USED: //"� ,n,// <br /> Depth to water Casingtype 4,r `t'� /'l/L <br /> YP <br /> Mix Ratios / Blank _ ft. Screen ft. <br /> Installation Method Slot size__ <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />