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.' .t• �+ MONITORING WEU INSTALLATION REPORT <br /> Date: 2, <br /> CONSTRUCTION <br /> Premise Address: , <br /> Total Depth Q <br /> WeI] No.: _ Z Screen Length (horn)_ }S I (ta) $� <br /> Filter Pack (from) (to)" -� r <br /> Inspector. Bentonite (from) to) <br /> Grout (from) ' ` ( <br /> i <br /> Permit No, Drilling rig type <br /> Auger O-D. I.D. <br /> Drilling Company: Completion - Stove pipe/cluistie box (circle one) <br /> Driller. `�' <br /> ti �,,,.�.,�-, T �-� casing <br /> Consultant 3 ` + r?- he_cht ~� <br /> Geologist tl 1.k, 1 1 e ` <br /> SPECIAL PE��MIT 1 p; '� r CCkFLE-7CN1 c4ii Y-aox <br /> f m :t e z COMPLii <br /> . ` y' Geavird.5uixa `71CH <br /> Disrance to sewer <br /> line <br /> Domestic well on site .site <br /> If.yes, location and <br /> � ante <br /> f r ... Is .� • 4 a � /. - �� e� � O <br /> LAMi <br /> Nordin! f ! a ,t� r•r , 1,1 <br /> 0 <br /> rai" c <br /> g Tempi rarure Y t f`` t rr- r d :ac-cn <br /> Method. t <br /> Screening <br /> TrackingiSh.cer 114 <br /> - <br /> Storage Method $�j' % { F. <br /> Cont 'x ' . !" � <br /> amination N • n Mt1TER7ALS HVEE.OPNIEN ' �. ,_d <br /> Storage Location oted • <br /> Casing type �. <br /> Blank <br /> GR— N. t size <br /> r� • '{ ` • ►' Slot , Screen <br /> ! ft. <br /> t, Bags cement <br /> Depth to water N Z-013' Buckets bentonite <br /> Mix Ratio - ` C .,4„4. ,Bags sand/gravel <br /> Installation511 <br /> thod Filter,Pack type/size " <br /> Q,,antity Inccd <br /> Surge BIock: - y 12 k ' <br /> ) <br /> On <br /> Discussed with • t: • O } <br /> EH 2 9 <br /> :j {-� C Type of nctlxod <br />