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[ <br /> MONITORING WELL INSTALLATION REI-- ,T --rr <br /> S'GP ( � /ZOO?— { Q J2rc4ir2��-� <br /> Date: CONSTRUCTION <br /> / f� 1 <br /> ?remise Address: ZLL _U ► ` Total Depth 2 C7 23 <br /> p / Screen Length Cfrom) (to) <br /> Well No.: MW Z /S / b ICSr uLVI � Filter Pack Cfrom) (to) <br /> Bentonite (from) (to) <br /> Inspector- � © �/`'/ t Grout (from) (to). _ <br /> p Drilling rig type <br /> Auger O.D. <br /> Permit No. [.D. <br /> mpany <br /> S 7 Completion -S-- pipe/christie box (circle one) <br /> Drilling Co <br /> casiaq <br /> Driller. M&Cheight <br /> Consultant <br /> 2 ' • <br /> Geologist (- v ` AMVE-GROUND <br /> CC&F c-7MN COMPLY CN <br /> SPECIAL PERMIT INFO. (3=rd Sulam 7 - <br /> Hat <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) f <br /> [f yes, location and distance - h <br /> a I •V ' <br /> v <br /> SAMPLINGwccn r <br /> Holding Temperature _ 7a"a pal*Method `MC(A <br /> Screening Method = <br /> Tracking Sheet • C Y/ n) <br /> SPOILS <br /> Storage Method MATERLALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank Steen fc <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to w7Metdlhio�dd�----j <br /> Bags sand/gravel <br /> Mix Rarios Facer pack type/size: - (y <br /> Installation DiscSurge Block - (y/ n ) <br /> Quantity Installed Type o ed with geologists - C'yJ/ n) <br /> Type of method �� <br /> EH 29 29 U <br />