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bey r0. <br /> MONITORING WELL IN"ALLArT�gN FORT <br /> Date: ?/-Z°bti ,. <br /> CO <br /> F <br /> Premise Address:,?-O!�-60 Total Depth- <br /> Screen Length (from) (to) <br /> Well No.: A- w /?/L- Filter Pack <br /> p (from) (to) <br /> Bentonite,onite (from) (to) <br /> f 'Grout (from) ` (to) y, t <br /> C K ��b Z� 9 • \1.� Drilling rig type <br /> Permit No? Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: Lf <br /> Driller: 1 <br /> caning � <br /> height <br /> Consultant IN. <br /> Geologist <br /> ABOVE-GROUND <br /> COWPL.ETION CHR 'rY-8OX <br /> SPECIAL PERMIT INFO. Graind Skxfacis <br /> COMPL E T7CN x i <br /> Distance to sewer line out ` <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - ft. <br /> 1 <br /> m 1 <br /> r <br /> N�' SAMPLING <br /> A <br /> tac5a <br /> Holding emperature c <br /> a <br /> Method _ 7&V' Pack <br /> Scree ng Method <br /> Trac g Sheet - ( y/ n — <br /> .a <br /> SPOILS /UA <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n } ' <br /> Storage Location Ca nJr— <br /> sing type <br /> I <br /> - - - Blank- ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water bentonite_ <br /> Depth �S Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br /> I <br /> i <br />