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MONITORING WELL.INSTALLATION REF.r�cT <br /> I <br /> - - 1 <br /> '�tUC't•EON <br /> Date: CONST <br /> � - <br /> r-� Total Depth <br /> ?remise Address: - CL°) <br /> Seen Length (Erorn) <br /> \AJJ i Filter Padk (from) 3' (to) <br /> Well No.: A Bentonite Vrom) <br /> p 1� Grout (from) Cto) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. . <br /> Permit No. chne box (circle one) <br /> Completion - Stove Pipe/ <br /> Drilling Company: CA <br /> cas Lng <br /> Driller, + :tei ghu <br /> V 7 : <br /> Consultant_ <br /> —9, VV <br /> GeoEogist ABCVE-G,RC(JNO ' <br /> p»5iiS7`!-30X <br /> CC&PLEMON <br /> SPECIAL PERMIT INFO. G=nd SLeacs <br /> _. trout <br /> Distance to sewer line 1 <br /> Domestic well on site - { y/ n <br /> [f yes, location and distance - S f C 19 ft <br /> 1 Z �lsL :1_. - <br /> -S = <br /> - � a <br /> C — s <br /> SAMPLING Zp :loctod <br /> Holding Temperature <br /> -Method <br /> Screening Method - <br /> Tracking Sheet - C y/ n ) <br /> Z <br /> SPOILS <br /> Storage Method MATF_AiALS/DEVELOPMENT <br /> _ f Contamination Noted C Y n ) S Ca2.sin��ype <br /> Storage Location C,Ke;sk g <br /> Blank ft. Screen ft. <br /> size <br /> GROUTING f 3 5[/S Bags cement <br /> ,4� - Buckets bentonite <br /> Depth to water pJAWgs sand/grav <br /> Mix Ratios - S - .ater Pack <br /> Installation Method 5'(},s 2831 Surge BI°I C Y n ) <br /> Quantity Installed " iscussed wt logisr- - C Y/ a) <br /> Type of method <br /> EH 29 29 <br /> 43 <br />