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MONITORING WELL INSTALLATION REF..,cT GGY <br /> Date: `���/� /J� y� CONSTRUCTION <br /> premise Address: L'l 7 L S • �/�IXG r Total Depth <br /> 7 Screen Length (from) (to) <br /> Well No.: � 2, J Filter Pack (from) (to} <br /> Benronite (from) (to) _ <br /> Inspector. Cdr Grout (from) (to) <br /> Drilling rig type ' <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller. easing <br /> height <br /> Consulant ♦� r <br /> k7 L. r 7Q <br /> r <br /> Cfeolagut ABCVE-.;AWND CYRIST 30X <br /> CCW'_c7,CN COMPLE CCN <br /> SPECIAL PERMIT INFO. Ground sAzf'c' <br /> r <br /> Distance to sewer line -V� <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - <br /> .r <br /> e <br /> a <br /> a <br /> SAMPLING do Rad Z = a <br /> Holding Temperature �' _ _ .r+�Pck <br /> Method <br /> Screening Method <br /> Tracking Sheet • ( y/ n ) <br /> tL — t tt <br /> SPOILS <br /> Storage Method MATERIAIS/DEVELOP^/CENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank fc Screen K- <br /> Slor size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 0•9 V Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist - (y/ a) <br /> Type of method <br /> EH 29 29 <br />