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"ONITOItING WELL I EtEPO b� <br /> k.k <br /> ma` • ` . Y 4,+'# . 'ti'�'� '� �4 3 �� x`+W .. � � }'h�„�; �F .0. / 'yA: . , .. <br /> Date: IVIRIC90tI - <br /> CONSTRUCTION <br /> Premise Address: � '-` q Total Depth <br /> Screen Length'(from) r (to) <br /> Well No.:Auk)9/Z- � Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: " Grout (from) (to) <br /> -Drilling rig type <br /> Permit No. % , Auger O.D. I.D. <br /> N. Completion = Stove pipe/christie bozo (circle one) i <br /> Drilling Company: l� <br /> .Driller: casing <br /> height . <br /> Consultant <br /> T <br /> • Geologist ._ <br /> ABOVE-GROUND <br /> CO F LE- DON C}iA 15`TY 8O X <br /> COMPLETION I <br /> .SPECIAL PERMIT INFO. Ground Surface 1 <br /> .Distance to sewer line Oram <br /> Domestic well on site - (y/ n ) ... <br /> If yes, location and distance - <br /> P � l <br /> SAMPLING ° ` <br /> ro&louad <br /> 4Pc9cn <br /> Holding Temperature <br /> Method qr" <br /> Screening Method t <br /> Tracking Sheet - (y/ n ) ' <br /> tt. L= tt. <br /> SPOILS <br /> Storage Method MATERIALS EVELOPMENT ! <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge BIock: - (y/ n } <br /> Quantity Installed Discussed with geologist: - {y/ n ) <br /> Type of method <br /> EH 29 29 <br /> i <br /> l <br />