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MONITORING WELL INSTALLATION REPORT <br /> Date: 0 CONSTRUCTION <br /> Premise Address: l7Uf� Well No. - ) <br /> Inspectiar: Total Depth <br /> Screen Length <br /> __h <br /> Filter Pack -� <br /> Bentonite Pellets <br /> Permit No. Grout �. <br /> Consultant 4 L(LaCompletion-Stove pipChristie bo <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding T eratu� � atldc•uP <br /> Method_ C <br /> Screening Method 445 <br /> ABOVE-GROUND CHRISTY•BOX <br /> Tracking Sheet69n) COMPLETION COMPLETION <br /> Ground Surlaca <br /> SPOILS <br /> proal <br /> Storage Method �S <br /> Contamination Noted - yes 00 n• <br /> Storage Location Q Sf'j n• <br /> — 'ar <br /> SPECIAL PERMIT INFO. — <br /> r <br /> Distance to sewer line alortod"ctlon = <br /> Domestic well on site - yes no <br /> If yes, location & distance - — 9P <br /> ft. — irh. <br /> GROUTING <br /> MATERIALS USED: <br /> f <br /> Depth to water 115 Casing type 4" 4,-) �L <br /> Mix Ratios A "iK Blank 58 ft. Screen 2- ft. <br /> Installation Method Si��/ 11'� Slot size_ <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> • L��' ��L, ��-�,�rlc, 6•Bags sand/gravel <br /> `1 �� Filter Pack type/size <br />