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NITORING WELL INSTALLATION REF <br /> u <br /> Date: 4117) 1 r CONSTRUCTION <br /> Premise Address : 21 $"H F� l AiioLOJ ° 01�h ml \ Total Depth Ll a' <br /> dpj J Screen Len (from) 410 (to) Z6 <br /> Well No.: MW � f 0 SJ 4v Filter Pack (from) I $ (to) 4 O <br /> Bentonite (from)_(to) t 8 <br /> Inspector: G. & Grout (from) t bb (to) ct <br /> 73$ Drilling rig tYPe_j <br /> Permit No. s Q D Auger O.D. K I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: F+ <br /> Driller: casing <br /> height <br /> Consultant T M � ✓Ufa' Ar /} C-� �r <br /> ` t < <br /> Geologist <br /> ARCVE-GACUNDCHR , <br /> COWLFIION CN <br /> SPECIAL PERMIT INFO. Ground Sara' <br /> Distance to sewer line gf <br /> cut <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - <br /> Z b F4. <br /> SAMPLING ° <br /> rImloC <br /> bb $ecti*c <br /> cn <br /> Holding Temperature s• <br /> Method <br /> Y <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> 4 0 ft. m tie <br /> SPOILS <br /> Storage Method Of 9"M MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) Z ii <br /> Storage Location Casing type ��� s�►a • �� <br /> Blank ft. Screen 1t. <br /> Slot size <br /> GROUTING Bags cement^ C106k <br /> Bucketsbentori[e b The emot <br /> Depth to water Bags sand/gravel h uf�• �3 <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y / X <br /> Quantity Installed Discussed with geologist: n <br /> Type of method <br /> EH 29 29 <br /> t, <br />