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NITORING WELL INSTALLATION REF <br /> �ool✓�ell S�^M <br /> Date:_ ho/ W CONSTRUCTION <br /> Premise Address: a� tlo,DGy Total Depth <br /> Screen Length (from) -644 I 1 1 (to) <br /> Well No.:��1j�3�7 Filter Pack (from) } r l I (to) <br /> Bentonite (from) 54" (to) Z's- <br /> Inspector: _ (�abt�'GI Gon (� Grout (from) 2 4 (to) <br /> Drilling rig type_�SI <br /> Permit No. s &U O 7 U Gti Auger O.D. '' I.D. ' <br /> Completion < tove pi /chrisde box (circle one) <br /> Drilling Company: 6Je�VAW pl_A <br /> Driller: casing <br /> height <br /> Consultant_ <br /> Geologist <br /> ABOVE-GACUND CHR*TY-BOX <br /> COWL17{ON COMPL.FTICN <br /> SPECIAL PERMIT INFO. end sudacs - <br /> Distance to sever line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> — m <br /> M. ve C <br /> SAMPLING — <br /> 7j E <br /> &�CJCn -- <br /> Holding Temperaturey�C <br /> Method tOd4''14' ? _ caval pacs <br /> Screening Method NJA <br /> Tracking Sheet - ( y/ n ) <br /> tt. — ito <br /> SPOILS ,, 1� <br /> Storage Method_ �► � S MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location vll�i'}� Casing type 5e 4• 14D PVC <br /> Blank 6 '4 ~ 3 ' `—ftp.r,�PeScreen_ $7- ft. <br /> Slot size . GZ nfh- "op <br /> GROUTING Bags cement„04716, ShOtol 0/ O''3r <br /> Buckets bentonite_ I bath sD l , <br /> Depth to water VOCW'l Bags sand/gravel �/ �$ Sr„��1 -v 1(,S >,•,s9 <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Voi -tbroa hose Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br /> a*-F . fa ro 15. ;,� <br />