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0 <br /> ONITORING WELL INSTALLATION REP61 <br /> rem <br /> OL <br /> ff�R �ON <br /> CON <br /> Date <br /> Premise Address._ Total Depth IV? <br /> screen Length (from) <br /> Well NoAAL tjAj <br /> Filter Pack- (frorn)' <br /> .:_ <br /> Benronite (from) <br /> Inspector.- Grout (to) <br /> Drilling rig iyoe"M' <br /> Permit No. Aug'erO.D. <br /> Completiow.ii;Stove pipe/christie box *(circle <br /> one) <br /> Drilling Company. <br /> casing <br /> heb;l <br /> TjL <br /> Consultax <br /> V <br /> Geologist <br /> AYE-GRC" CW* <br /> f 8OX <br /> SPECIAL REMI IaO ........................... , C�roctnd Macs <br /> tt <br /> Distance to sewer line�. <br /> Pomestic,well on site y1 n) bg <br /> If yi s 1601tift and distance- <br /> ........... <br /> r. <br /> V <br /> low <br /> AWLING <br /> NIL <br /> olding T-Amperature <br /> Method <br /> Are <br /> Screening MethodEE <br /> Tracking Sheet l n <br /> ft <br /> Storage Method. <br /> �Contaminatlon:Noted - rL <br /> Storage Location,, Casing <br /> Blank Si <br /> Slot size <br /> -GROLMNGe Bags cement <br /> DA-dl at <br /> Buckets bentonite <br /> 4 <br /> Depth to lyaterli47 Bags sand gravel <br /> Mix Ratios ;: Pack type/ e 44 <br /> Installadon Method WOO il I ii o k 0 e <br /> Surge Block: - (y 11 <br /> Quantity Installed Discussed with`geologist. • A <br /> Type of th d <br /> me., 0 <br /> 41 <br />