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J . UU <br /> woo <br /> MONITORINtor WELL INSTALLATION II<EEPOAT <br /> �[ Zeno Mw - I <br /> Date: 1. A. y 2610 0 CONSTRUCTION <br /> Premise Address:- �:4 0!✓ 1��= Total Depth <br /> AI Screen Length (from) �� (to) t t— <br /> Well No.: <br /> N f Filter Pack (from) ZJ_ (to) <br /> '• , Bentonite (from) a (to)3"3- <br /> Inspector. Vu N V1 Grout (from) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casinq <br /> consultant � r t <br /> T height <br /> Geologist A l.:i-E - <br /> ABOVE-GACUND qHMM-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO, GrOW4 Sudan �•�••� <br /> Distance to sewer line /Uo c.`%1J, OWA <br /> -Domestic well on site - (y A Nekori � <br /> if yes, location and distanced M Lx&fi°P <br /> �Ett <br /> 14 rltr � <br /> SAMPLING <br /> Holding Temperature_v <br /> Method „ = gray.l padt <br /> Screening Method <br /> Tracking Sheetft. <br /> r <br /> Z J ,., _ <br /> SPOILS <br /> Storage Method 1;kr ?� ' MATERIALSMEVELOPMENT <br /> Contamination Noted- (y/ 3 Z i, 1/L, <br /> Storage Location_ 0 _ S%�e �' Casing type <br /> �Fa N/� Blank 6 ft. Screen 2 ft. <br /> Slot size ►Ofo <br /> 3- <br /> GROLITING Q C 7 Ba dent <br /> Buckets bentonite <br /> Depth to water B ,n Bags sand/gravel <br /> Mix Ratios I l Filter Pack type/size z <br /> Installation Method y a/A Surge Block: - (y/ <br /> #W-It Installed #W-ItDiscussed with geo 'st: - ©/n) <br /> Type of method <br /> EH 29 29 jf,`' <br /> I VJ <br /> U aka <br />