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LLATION R. ,-.j�T <br /> MONITO G WELL INSTP � <br /> z0 �� <br /> ( �2 1 8 ` zS �q F10 <br /> M All <br /> � s.µ <br /> . ; �S ,�, , <br /> ,. Q 4o <br /> Dare: U"��- gOOZ _ C U ON d ? f� <br /> ?remise Address: <br /> Z d u Total Depth G <br /> (to) <br /> 4!=enLength (from) <br /> te <br /> Well No.: j <br /> Pack (from) <br /> Z to) 2. <br /> Bentonite (from) _ ( <br /> Inspector: . Grout (from) z (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. `� v I.D. <br /> Complation - Stove pipe/christie box (circle one) <br /> Drilling Company* —� <br /> I r car L:19Driller. (� 7- he?ght <br /> � 1 � �• I <br /> Consultant ✓�' T <br /> p <br /> Geologist Y� t/�..;RCUND <br /> C7-sA15�^!30X <br /> / W3 twtv�!TICN XvPC=iCCN <br /> SPECIAL PERMIT INFO. Ground Suiacs 4 <br /> - i r � <br /> B�` g i , o groat <br /> Disrance to sewer line '_ MV <br /> /, F <br /> Domestic well on site - ( y/ n ) `�- <br /> If yes, location and distance - — �- <br /> CYC U _ e <br /> 2 <br /> SAMPLING etatrad = a <br /> ,,A � •f saccn = <br /> Holding Temperature — U �� `Y _ 71y9i Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n '` <br /> ;�, ♦ = Y it <br /> SPOILS <br /> Storage Method MATE?JALS/DEVELOPMENT <br /> Contamination Noted - (y; n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slotsize <br /> GROUTING Bags cement <br /> r Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist•- - ( y/ n) <br /> Type of merhod <br /> EH 29 29 <br />