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1 <br /> MONITORING WEtb INSTALLATION PJKP .eT <br /> Date: p `��` �� ' CONSTRUCTION M3 / ML ' <br /> Premise Address: i Toral Depth ✓ � <br /> A A Screen Length (from)T,i_(to) —' <br /> Well No.: AA %r � / 0 ` � Filter Pack (from). (to) 3 "; <br /> e Benronire (from)=(to) ?� c9 <br /> Inspector. I � y ��/ Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. tr I.D. <br /> Completion - Srove pipe/christie box (circle one) <br /> Drilling Company <br /> casing <br /> Driller. ( � I <br /> =6L height <br /> Consultant <br /> PzC� MN I r717 V 7WO1 <br /> Geologic[ �\A Z r <br /> - ABCVE-u^ROUNO <br /> cCWLc=N Compu=lICN <br /> Grousurf <br /> SPECIAL PERMIT INFO. 5 y � � <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y n ) `t- <br /> If yes, location and distance '[y, ^ fte <br /> t <br /> 7NVV <br /> y17scrrl <br /> SAMPLING QC �P i5 '1D <br /> Holding Temperature <br /> skoe k 3o So <br /> Method <br /> Screening Method a _ _ <br /> Tracking Sheet • ( y / ii ) O <br /> IVY n <br /> SPOILS Sir ^ 36—,W <br /> Storage Method d ^ 7q MATERIALS/DEVELOPA ENT <br /> I <br /> Contamination Noted ( / n ) b � 25 Casing ryPe <br /> Storage Location .Blank Bunk ft Screen <br /> Slot size Q Z� <br /> Bags cement <br /> GROUTING I °� Buckets bentonire <br /> DC Bags sand/gravel <br /> Depth to water <br /> Mix Ratios Filter Pack typ <br /> Installation Method Surge Black 11 <br /> 11( / n ) <br /> Quantity Installed - Discussed with geologist - ( y <br /> Type of merhod <br /> EH 29 29 t 1 <br /> C _ _!kl /I J <br /> my <br />