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MONITORING 4`1qk;1RI1P&kj4q,'ION REPORT <br /> U <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> Date:!'!AI"G h 2la f / / Z CONSTRUCTION <br /> 160`/ So�•►ti 8 s7" --- <br /> Premise Addreser CK 7-0 Well No.-__ Inkv- _ <br /> Inspector: ci„yt ! Cril.+VX Total Depth -7 <br /> Screen Length /�' :-3 " ! <br /> Filter Pack_ &I- - <br /> Bentonite Pallets__.___ <br /> Permit No. Grout_ <br /> Conault3ntA/ipiv GEDsf:entc Completion-'Stove pip4 - cieti;� 13r, <br /> Ceplogit�t_�►'��9TTffb"F✓ �_ y/e�- _ -- <br /> Auger O.D. - <br /> Auger I.D, <br /> SAMPLING - - <br /> Holding Temparature—• *00k-up <br /> M-t hud ~� <br /> :.'v reening Method___ T <br /> A901I�-GROUND CKMSTY4• 0.4 <br /> Tracking Sheet (y/n) _ COMPLETION COMPLETiUN <br /> SPOILS Otound Surtwo ..-+- ---+ <br /> grOVt -- -- <br /> S; ardge Mathud <br /> contamination Noted - yes/no n <br /> Storage Location„_ . <br /> 63 <br /> tt, <br /> S t-Q1A —PN;RMIT INFO, _ • <br /> abtUd <br /> " aaCatics to newer linem moo„ <br /> ,tiut+atlL well on site yes/no <br /> '+ yea, location & distance - = gravel P- <br /> -,7 tt 7P n <br /> 41RUU1C7�N0 <br /> MATF,RIAL5 USED: <br /> Depth t,, water _ 0�_ ` . Casing type <br /> s/i g O �'�t <br /> Mix Ratios A Blank _ ft. Screen /S rt, <br /> Inat"llatlon Kethud "Tic,..:t Slot size 4 nvL. <br /> �-,Antity 1-natalled __/��� Bdg9 Camunt _ <br /> Bmckuta bentonite M <br /> Sags aaad/gravel <br /> F I-ILer Pack type/aizc Nf ��,',. r,�6•. ; <br />