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l <br /> - <br /> ' MONITORING WELL INSTALLATION REI--KT . <br /> Yt- <br /> Dare:,l/ Z 5/0(i <br /> ?- remise Address: novo CGU 1 s�o--1--(� Tota! DeprhS 11Gi11 r(fuS ' <br /> Screen Length (from) (to) <br /> IN -Filter.Pack; (from)T (to) <br /> Well No.: <br /> Bentonite (from)" -(to) <br /> if ,Kb-(� Grout (from) (to) <br /> Inspector ` <br /> Drilling rig type <br /> Auger OD. 1 I.D. <br /> Permit No. Completion - Stove pipe/curistie box (circle one) i :. <br /> Drilling Company i <br /> .:Cas L.-Ig <br /> Driller.. U"'-�"�'' � he_9hr <br /> Consultant f-F1M�� <br /> Geologist OX <br /> y /�gCyE�;ROtiNO <br /> 4VsApL_XON 4 S (.4Cr�—S1A1 pJ 1 i `V./X <br /> SPECIAL PERMIT INFO. k <br /> ' S r Mout <br /> Distance to sewer <br /> Domestic well on site - { y n �- <br /> If yes, location and distance - slomad <br /> SAMPLING <br /> Hemp nature .l ' <br /> Holding T <br /> Method <br /> Screening Method <br /> Tracking Sheet - C y/ n } <br /> tL <br /> SPOILS 'x <br /> ' ► � 5 �° y ..l ms'µ ' .; - <br /> >storage lvtethod MATFR[ALS/DEVELOPMENTy; ., I <br /> Contamination <br /> . Not4 n Casing.typ <br /> Storage Location _'BlankLL,e <br /> ►� tift. Screen <br /> Slot size <br /> GROUT TNG Bags cement i <br /> Buckets bentonite i <br /> Depth to water �lJ� Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method_ A- - Surge Block: - (y/ n } <br /> Quantity Installed Discussed with geologist: - C Y/ n} <br /> Type of method <br /> EH 29 29 <br /> I <br />