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4 <br /> MONITORING WELL INSTALLATION REPORT <br /> Dates Z-- CONSTRUCTION <br /> Premise Address:—/f - r' Well No. <br /> Inspector• Total Depth �S <br /> Screen Length -?S- S' <br /> filter Pack V5 4- <br /> �7 G� Bentonite Pel to <br /> Permit No. o' / Grout — O <br /> Consultant /G� �� Completion-Stove pip Christ <br /> Geologist(isra.1� <br /> Auger 0.D. <br /> Auger I.D. .-- Y �` <br /> SAMPLING <br /> r <br /> Holding Tepperature /«. sSdc-up I <br /> Method <br /> Screening Method ,& C? / T . <br /> AE&E-GROUND CmRiSTY-Box <br /> Tracking Sheet (y COMPLETION COMPLFTlON <br /> SPOILS ��5ewe <br /> /sv/�s 9101AStorage Method o/ I <br /> Contamination Noted - yes ••••--�tt• x <br /> Storage Location <br /> SPECIAL PERMTT INFO. <br /> e <br /> Distance to sewer line 4/! /e�✓/ <br /> sioiad <br /> &soon <br /> Domestic well on site - yea no <br /> If yes, location & distance - Z'.... = gr&vW Pack <br /> it. <br /> GROUTING <br /> MATERIALS USEDz <br /> Depth to water, / � Casing type <br /> Mix Ratios Blank ft. Ser on ft. <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite r/ <br /> Bags sand/gravel <br /> Filter Pack type/eize <br /> 3 7 r- <br />