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�Kw <br /> MONITORING WELL INSTALLATION RE# <br /> Date: CONSTRUCTION <br /> NJy �«yyIJ Total Depth �� <br /> Premise Address: nn 1, I Screen Length (ftm). On (to) - <br /> Vv <br /> Well No.: /r I - Filter Pack (&Om) _ (ro) <br /> } Bentonite (from) Cm) <br /> inspector: P Grout (from) - (to) <br /> Drillingng tYPe <br /> Permit No. Auger O.D. LD. <br /> ' Completion-Stove pipe/chrisde box (circle one) <br /> Drilling Company. r4 <br /> Driller. �Z 99 casinq <br /> height <br /> Consultant <br /> Geologist ROUND <br /> COWLETION COMP ---=N <br /> COMPL-'TiCN <br /> SPECIAL PERMIT INFO. Ground Sit <br /> s <br /> Distance to sewer line - <br /> ! <br /> Domestic well on, site - (y �- <br /> If yes, location and distance fL <br /> �W�=) <br /> ai r-, ;rrtaa-��� Loarµt/ <br /> Dr,"K <br /> ✓a <br /> o <br /> SAMPLING t1oc'� <br /> "Own .. <br /> = . <br /> Holding Temperature SGC - padc <br /> Method <br /> Screening Method _ <br /> Tracking Sheet - C Y/ a) = <br /> & � = n <br /> SPOIts <br /> Storage Method MATERIALS/DEMELOPMENT <br /> Contamination Noted - (y L/ Z," QAC <br /> Storage Location L/ 6� S��r <br /> Slot size o\"Z> <br /> GROMING t, <br /> Buckets bentoanite <br /> Depth to water PO Bags sand/gravel ► �' <br /> Mix�� Filter Pack me/size 12 <br /> ----.4=Installation Method Surge Block: - C��n <br /> Quann InstallDiscussed with <br /> tY I Type of method <br /> EH 29 29 <br /> Mw I Z rn <br /> {bZ° 2S <br />