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"'dONTTORING-WELL INS" <br /> TALLATFoN REFIT <br /> • . <br /> Date., PS" <br /> / CONSTRUCn O N <br /> Premise Address: JALO�' Wpm LU ?U <br /> Total Depth <br /> Well No.:� IJ I L Screen Length (from) O (to) a <br /> nn Filter Pack (from) d (to)i <br /> Inspector:_�x Bentonite (from)4_L <br /> Grout (fro (to) <br /> � <br /> Permit No. O 0 6 Drilling rig type <br /> Auger O.D. I <br /> 9r4l <br /> ipe/chrisI.D. <br /> Drilling Company-.. Completion - Stove ptie box circle one) <br /> Driller: <br /> • .. � casing . <br /> height <br /> gi �� \ <br /> Geolo st_ �- <br /> ' ABOVE-GRCUND <br /> CONPLETfON G-�iSTY 3aX <br /> SPECIAL PERMIT INFO N <br /> C�r�ur�Stxixr <br /> Distance to sewer line <br /> Domestic well on site -,(y/ ) <br /> If yes, location and distance _LZ_�ft. <br /> —ft. ft' <br /> Vi O <br /> M <br /> r <br /> SAMPLING T' <br /> •toro1i :i c <br /> iT.O� sacicn _ <br /> Holding Terp,p erature ``�C <br /> Method 15A.4-J^ efmlfiz, <br /> Screening Method O <br /> Tracking Sheet - / n <br /> _..ft. <br /> 11 r 30 <br /> SPOILS n <br /> Storage Method &✓►A.A MATERIALS'/DEVELOPMENT <br /> Contamination Noted - r� _e <br /> Storage Location dl,-- Casing type_ NSCt. <br /> Blank-(&_ fc. Screen-2.e. <br /> SIot size O.Ow <br /> GROUTING Bags cement 2 <br /> Buckets bentonite I <br /> Depth to water /� � Bags sand/grav 65 <br /> Mix Ratios Filter Pack type/ ize A( <br /> -Installation Method Surge Block: - (y/Q} <br /> Quantity Installed t. Discussed with geologist: <br /> Type of metliod <br /> 1;H 29 29 <br />