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MONITORING WELL INSTALLATION FEU# <br /> q t r <br /> CONSTRUCTION I <br /> Date: D I KJ 1 J , �i o , <br /> ��"'"' <br /> Total Depth <br /> Premise Address: N Screen Length (from) ��.,L.--- <br /> (to) <br /> C Filter Pack (from) a I _(to) <br /> Well No.: G Bentonite (from) <br /> Grout (from) ,(to) ,An.Lr„c, <br /> Inspector. ` Drilling rig type <br /> 3, I Auger 0.1).7— <br /> Permit No. I Completion <br /> - Stove pipe/ stie bo (circle one) <br /> Drilling Company: I casing <br /> hei5ht <br /> Dnller:' � � .qr <br /> Consultant—= <br /> I' n_ nY-� ABOVE-GRCUND C'Rn sT Y-3ox <br /> Geologist CONFLFTION Gompt_cTION <br /> ^��C�wnd S�rlaca <br /> SPECIAL.PERMIT INFO. prat <br /> Distance to sewer line 1 IL <br /> Domestic well on site- (y/ n) tt• <br /> If yes, location and distance - <br /> _ OC. <br /> lior.➢dd <br /> SAMPLING socicn <br /> _ oval pa¢t <br /> Holding Temperature r <br /> Method <br /> Screening Method s. <br /> Sheet - (y/ n) tt <br /> Tracking <br /> SPOILS rEL <br /> —�COPYM�nEsNC <br /> MAT <br /> Storage Method t � yCaig YPContamination <br /> y�r <br /> een1 gc <br /> Storage Location Blank <br /> Slot size <br /> Bags cement <br /> GROLMNG Buckets bentonite <br /> Bags sand/gravcl <br /> Depth to water Fater Pack type/size <br /> Mix RatiosSurge Block: - (Y/tl) <br /> ,Jnstallation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />