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MONITORING WELL INSTALLATION REF-.,.eT <br /> Date: CONSTRUCTION <br /> ,ct f <br /> ?remise Address: 116) YA'C PV&rjJ Total Depth S� <br /> Screen Length (from) (to) <br /> Well No.: . Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. LD. <br /> Completion - Stove pip Christie box (circle one) <br /> Drilling Company: <br /> Driller. I Cas he <br /> h <br /> T eight <br /> Consultant <br /> Geologist ABCy=--GpCXJNO <br /> Gri�P�..R'SON Ct-R�5^!-30X <br /> COWLriiCN <br /> SPECIAL PERMT INFO. Ground Sul'c' <br /> Distance to sewer line 1 <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - I, <br /> a <br /> SAMPLING :toctad <br /> saccn _ � <br /> Ll Or <br /> Holding Temperatur `I = 1°i <br /> -Method <br /> Screening Method L <br /> Tracking Sheet - / n) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPN ENT <br /> Contamination Noted - (y/ n) Casing ttb <br /> Storage Location Blankft SteenSlot size <br /> GROUTING Bags ceBuckets� Bags sanDepth to water 7 Filter PaMix Ratios ✓1i` 'C' r Surge Bn )Installation. M tho "�A � ,Quantity Installed Discusselogisc - C Y/ nType of <br /> EH 29 29 <br />