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MONITORING wELL INSTALLATION R U--. T <br /> Dare: e-TI 5106 67 b 0�' CONSTRUCTION <br /> ?remise Address: V a Z S ' Total Depth <br /> Screen Length (from) 37. <br /> M W Z /k UJ 1 M u' 3 Filter Pack (from)) —(to) 1 5 <br /> Well No.: } . I Bentonite (from) f� (to) 1 Z <br /> Co Q Grout (�' (t°)-� <br /> J Inspector. 'I Doming rig typeL 1 <br /> 1 SZO(2`t 65 Auger O.D.A�T I.D. 1� <br /> Permir No Completion Stove pipe/christie box (circle one) <br /> M , <br /> 1 <br /> 5 Drilling Compar {k <br /> casing <br /> � Driller: �- he;9hc <br /> ♦� 7 <br /> Consultant <br /> L <br /> Geologist I O <br /> /18CVEv^AWNO d-Sim-oOX <br /> OC&FL7,CN CCMP�_TiCN <br /> G=rYl Strfaca <br /> SPECIAL PERMIT iNFO. <br /> �ra.2 <br /> Distance to sewer line IJ4 j t <br /> Domestic well on site - ( y/ n ) t <br /> If yes, location and distance �-- <br /> r - - <br /> 3 <br /> I — e <br /> SAMPLING VV ween <br /> G 71V91pack <br /> Te erasure <br /> Method = I <br /> Screening Method 'v /Z - <br /> Tracking Sheet - / n ) = t _tt <br /> SPOILS <br /> Storage Method <br /> S MATERIALS/DEVELOPNENT <br /> Contamination Not d <br /> - C' ) _ / Casing type z rl d � <br /> Storage Location SXa.tl Blank ft Screener <br /> Slot s12 <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> 2yi Bags sand/gravel <br /> Depth to water Filter Pack type/aze 7 <br /> Mix Ratios Surge Block: - (Y/V <br /> Installation Method Discussed with geologisc - (� n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />