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MONITORING WELL INSTALLATION REF--sir <br /> L-VA 0( C hau-(T— <br /> CONSTRUCITON <br /> Date: <br /> r�Vr— Total Depot <br /> premise Address: Screen Length (£tom) {ta) <br /> r q ! - l V Filter Pack (from) (to)� <br /> Well No.: `N LV� Bentonite (from) (to)— <br /> Grout (from) (to)_ _ <br /> inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove piipe/christie box (circle one) <br /> Drilling Company: <br /> :I@sQn <br /> Driller: W, VV 1771 <br /> i <br /> Consultant <br /> Geologist r YEwAOUND a.p�-,,y.SOX <br /> CC&Fi—c CNapt=i ICN <br /> SpECIAi. PERMIT INFO. d/' <br /> 2t h outDistance to sewer line • <br /> Domestic well on site - { y/ a ) �U� ^ <br /> If yes, location and distance - <br /> 73 <br /> SAMPLING <br /> _ 7sem Rack <br /> Holding Temperature 'CC — <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - { y <br /> SpOiLS <br /> MATERiALS/D�I.OPMENT V <br /> Storage Method <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank L1 " C' ft. S�eea <br /> Slot size <br /> Bags cement <br /> GRA G Buckets bentonite <br /> Bags sand/gravel Z <br /> Depth to water Filter pack typ e <br /> Mix Ratios Surge Block: C / n) 1 <br /> Installation Merhod Discussed wi geologist; - C Ya, <br /> Quantity Installed Type of method <br /> EH 29 29 OV <br />