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MONITORING WELT.INSTALLATION REP(- T �' •- <br /> Date: l©l 2�- K 1 J e.i.�C,vtiu �• CONSTRUCTION �ko 60' <br /> Premise Address: 11, l2 .66jAAAy,,t, Total Depth_ <br /> Screen Length (from) '16•S _(to) <br /> Well No.: AS - L Filter Pack (from)_ t --(to)- � <br /> Bentonite (from)_�,z'__ (to) <br /> Inspector: _��.-��n. t— Grout (from) (to} Ll <br /> Drilling rig type <br /> Permit No. d cl Auger O.D. •v4" I.D. <br /> Completion - Stave pipe/ e o (circle one) <br /> Drilling Company: onrX ry /& r1 <br /> Driller: \ .� iA)a. taa= (A)COOL) "f _ casing <br /> height <br /> Consultant lnd� <br /> Geologist ff) •� <br /> ABOVE-GROUND CHRMrY43OX <br /> CoNFLErCH CaMPLE=nON <br /> SPECIAL PERMIT INFO. Ground Strfact <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) q Z • t', <br /> if yes, location and distance - L tt, <br /> 4" m <br /> SAMPLING �$ J slottad y _ <br /> aeon <br /> Holding Temperature_ t�Aa_e�y]� v: graval pa& <br /> Method — <br /> Screening Method P I t� ' <br /> Tracking Sheet - n ) <br /> ' L <br /> SPOILS <br /> Storage Methodc� ('2- MATERIALS/ <br /> DEIJELOPMENT <br /> Contamination Noted - y/ n ) / <br /> Storage Location�'•�• • S nK�Jf(lit Umcly Casing type ?VC, 2` <br /> ������,-�� Blank, H.L..S ` ft. Screen �•S` fr. <br /> slot size o�-- <br /> GROLMNG Bags cement <br /> Buckets bentonite <br /> Depth to water N Bags sand/gravel <br /> Mix RatiosS a0 Filter Pack type/size <br /> Installation Method 3nxAqAA4,. Surge Block: - (y/,n7) <br /> Quantity Installed 3� (oo'(„$) Discussed with geologist: - (y/©) <br /> Type of method <br /> EH 29 29 � <br /> 104<'m-040 <br />