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MONITORING WELL INSTALLATIOI,,.,�–'ORT <br /> Date: �7 zoo <br /> CON�ON <br /> Premise Address: 1-7 Y 0"2, <br /> �• Total Depth 30 , <br /> G <br /> Well No.: W- / Screen Len <br /> Filter Pack (from)— <br /> inspector. ei.. (fr°'I')— Z--n_(to) Ig <br /> re (from) 1g )6 <br /> Permit No. 3 Grout (from)�(c (to 1 <br /> Drilling ri3type_8T--(to) <br /> Auger O.D. I.D. <br /> Dnllmg company, Completion - Stove pipe/ch istiebo — <br /> (ctrd <br /> Driller. 7— L=— eane) <br /> Consul[anicasing <br /> 4n height <br /> Geologists �t ' <br /> A°cvE•GROUNO <br /> SPECIAL PERMIT INFO. <br /> 0O&9LETION C7ASTYdOX <br /> Grundsutacs COMPL_nCN <br /> Distance to :ewer line < p <br /> Domestic T�-- <br /> well on site - C Y n T <br /> 1f Yes, location and distancQ grout <br /> .•-eft. _ = 1 �(t. <br /> SAMPUNG <br /> _ — c <br /> Holding Temperature .lord <br /> Method = B <br /> ScreeriingMerhod __ tM�a�c <br /> Tracking Shcet _ (y/ n) <br /> SPOILS <br /> It. <br /> It. <br /> Storage Method �j �� <br /> Contamination Noted . ( MATERI <br /> Storage Location Q n ) - ���'E[OPMEN�/T <br /> !i5ten type 6 r /011(— <br /> Q--7— <br /> Blank <br /> y <br /> GRO BIS--�_ft Screen l Z� <br /> �1J77\G Slot size <br /> •�l0 ' <br /> Ba <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/ <br /> Method gravel <br /> lnsrallation Filter Pack type/size <br /> Quant' <br /> ry Installed Surge Block: - C Y n <br /> EH 29 29 Discussed with geo ogist: - (y/ n) <br /> Type of method <br />