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MONITORING WEm nwALt.ATmAI,�'" <br /> Et <br /> • v ` <br /> Date: L V l �C( CONS'I'RUT <br /> O 1 <br /> P Remise Address: t1 U 7- �jgg PLA Total Depth <br /> Screen Length (kom)� —(to) 3 <br /> Well No: V l J Filter Pack (from) t b ' (to) � <br /> 6 Qe Bentonite (from) 34 (m) <br /> Inspector. �v In16/� , HZa Grout (from) 571 Jto) <br /> (7 ZZ� Drilling rig type c fl t(13 �, oar <br /> .— <br /> Permit No. Auger O.D. �r` I.D. ef,ZS <br /> Completion-Stove pipe/christie box (circle one), <br /> Drilling Company: <br /> Drier. casing P <br /> height <br /> Consultant l <br /> Geologist <br /> - <br /> COMPLETION COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. X Grourw SWaa <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ s 3 , n- <br /> If yes,location and distance ° -� it. <br /> J10- <br /> tD Qdo r <br /> aSAT#VLMd -- <br /> polo r <br /> Hol gTempe ture fa <br /> "^ r = gravel pact <br /> Method <br /> Screening Method pejo Y . = <br /> Tracking Sheet n30 <br /> ) <br /> �q <br /> SPO <br /> i <br /> Storage Method WP <br /> Contamination Noted - (y/n) �rQ <br /> Storage Location Casing type U C <br /> 7 ank 40 ft. Screen 20 ft. <br /> pp Slot'size /►. <br /> UTTNGBa 8s <br /> cement 6 <br /> � <br /> ,r1/ Buckets bentonite o <br /> Depth to water C4 )Bags sand/gravel <br /> Mix Rdtios 1 ' T Filter Pack type/ Sw''` <br /> Installation Method t Surge BlocW90 <br /> n) <br /> Quantity Installed Discussed gist: -�/ n) <br /> Type of method <br /> ` EH 29 29 <br /> A Od,r da o w,'nd <br />