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1 r <br /> �• :,4�`, � tf <br /> MONITORING WELL INSTAMATION REI-,,KT <br /> -6L4- <br /> Date: <br /> W►�R CONSTRUCTION <br /> f ry <br /> oT ss: ! 'n-r-b Total Depth <br /> remise Addre - — <br /> (� een I.engrh [from) Cto) <br /> Well No.: 4� - ,T CCPT'f11nrerPack (from} (to) <br /> ton_e (from) (to] <br /> Inspector Grour (from) (to) <br /> Drilling rig type <br /> Fermin No. Auger O-D- I.D. <br /> Completion - Stove pipe/cnristie box (circle one) <br /> Drilling Company: lIy i <br /> cas ing <br /> Driller heLghr- <br /> Consultant. Gca,� <br /> Geologic - ASCvE-GROUND <br /> =A.QLT30N CF�A1S!-aOX <br /> C-OMR-E N <br /> SPECL!LL PERMIT INFO:' ; <br /> r ' <br /> Distance to sewer line <br /> Domestic well on site - ( y n ) 14� <br /> If yes, location and distance - . „ S S <br /> - 3 <br /> 4k - <br /> SAMPLING <br /> Holding'Temperature <br /> Method '= <br /> Screening Method " — <br /> Tracking Sheet - C y/ n ) <br /> E <br /> SPOILS <br /> I <br /> Storage Method MATERiALS/DEVELOPMENT <br /> Contamination Noted - (y/ n } <br /> CasinStorage Location Blank <br /> e <br /> Bank •` ft Screen fr- <br /> Slot size <br /> GRO[.MNG Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block. - C y/ n ) <br /> Quantity Installed Discussed with, geologist: - C Y/ a) <br /> Type of mediod <br /> EH 29 29 <br /> � E <br /> .� <br />