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MONITORING.WELL INSTALLATION RERT � - <br /> Date: 0 • S/0 CONSTRUCTION <br /> cr �}_ rt <br /> Premise Address:, .2 !`1 _C�t des Q--S�r y Total Depth <br /> . "LVW 4 I fob Screen Length (from) (to) <br /> Well No.: C' $ �3 Q�nY1 �F Filter Pack (from) - (to) <br /> -� Ben'tonite (from) (to) <br /> Inspector, �i r��C�� Grout (from)- _(to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D.__ �� 2S "• <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller. � <br /> De' eIaSGo an "Leo 5'gnTDS 4�l e-ght <br /> .Consultant R 5 p/lh', V <br /> Geologist <br /> >. 1 A OVE-GRCOND <br /> CA W LE-DCN G}�i:Si'f <br /> u comet-=MCN <br /> SPECIAL.PERMIT INFO. { , G=rd Suiac� <br /> Distance to sewer line ^' <br /> Domestic well on site - (y/ei y <br /> - "-. <br /> If yes, location and distance - �. <br /> V' <br /> SAMPLING <br /> X <br /> Holding Temperature '40� , <br /> Method i e-e 'I-),L Coe__k y- <br /> t� <br /> Screening Method _ <br /> Tracking Sheet n ) _ <br /> SPOILS <br /> Storage Method COV ,lo .1_ MATERIALSIDEVEI.OPMENT <br /> Contamination Noted - (y n <br /> Storage Location en S,+O-' Casing type <br /> Blank___S A: ft. Screen —ft- <br /> Slot size <br /> GROUTING Bags cement 33, <br /> Te <br /> � <br /> Buckets bentonite NA <br /> Depth to water Bags sand/gravel At A- <br /> Miz Ratios - 14" pater Pack type/size <br /> i�►stalladon Method ` �rq� (,t- Surge Block: - (y/ n ) M j} <br /> Quantity Installed 3 e e Discussed Yrith geologist: - (y/ n ) <br /> Type of matliod <br /> EH 29 29 " F <br />