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Q.JV1.J <br /> �.NITORING WELL IN N REPO <br /> r <br /> Date: (/ ��� CONSR J=ON U✓.tJ�` ��� `` <br /> Premise Address: 01,79-S Total Depth <br /> Screen Length (from) (to) <br /> Well No.: �� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: _ Grout (from) (to) <br /> .Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> c� Completion - Stove pipe/clu-istie box ( ' cle one) <br /> Drilling Company:_ A4t+ <br /> Driller: casing <br /> helght <br /> Consultant , l _ <br /> Geologist <br /> ABCVE-GACUND �X <br /> SPECIAL PERMIT INFO. i G=nd Surf + <br /> Distance to sewer line �'N' gf0� <br /> r <br /> Domestic well on site - (y ) ��_,ft. <br /> If yes, location and distance - ft. <br /> LO- <br /> v;. m <br /> SAMPLING ` _ c <br /> a <br /> tocticn <br /> IN <br /> Holding Temper tune F <br /> Method _ <br /> Screening Method ;c; — <br /> Tracking Sheet - ( y/ n ) :` <br /> irft. <br /> SPOILS ?� 2 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) 2k <br /> ?U(' <br /> Storage Location Casing typ <br /> fW-1,50evyu Blank I 0 ft. Screen ft. <br /> Slot sizeO?D <br /> GaQ4P G � Bags cement <br /> Buckets bentonite <br /> Depth to water~ 6- Bags sand/gravel <br /> Mix Ratios �— Filter Pack type/size <br /> Installation Method Surge Block: - (y/n ) <br /> Quantity Installed f.� _ Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />