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AGE 2 OF Z <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: / / ( '`O CONSTRUCTION / <br /> Premise Address:?,-7620 UA-t,44s lam" Well No. /V'�V/ /-/Z- <br /> Inspector: Total Depth 3 ' <br /> tf, c> Screen Length <br /> Filter Pack <br /> Bentonite Pellets 1-Z <br /> Permit No. v- Grout - <br /> Consultant L Completion-Stove pipe/christie box <br /> Geologist <br /> Auger O.D. `9 <br /> Auger I.D. G T <br /> SAMPLING <br /> Holding Temperature stldc-up <br /> Method S [ A- S JOy!4 <br /> rfi n Ywy)s ry�L <br /> Screening Method P71 <br /> � � <br /> AE;pVE-GROUND CHRiSTY-BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> grout <br /> Storage Method <br /> Contamination Noted - yes/no ft. <br /> Storage Loc tion <br /> _ <br /> SPECIAL PERMIT INFO. = c <br /> -' o <br /> 810 ad <br /> Distance to sewer line suction —_ <br /> Domestic well on site - yes/rte <br /> grave!pack <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type <br /> ,dVC <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 /> Total Billed Time Per Site //37-5 <br /> Date Permit Finalized -//J-�7a <br />