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1 <br /> %-�NITORING wEu INSTALLATION REPbv4' <br /> Date: // 2L WN UOON <br /> Premise Address: U G' Total Depth � <br /> � Screen Length (from) (to) <br /> Well Not Filter pack (from) (to) _.. <br /> Bentonite (from) <br /> Inspector: ......—A <br /> Grout ( o ..� <br /> Drilling rig ` <br /> Permit;No. <br /> Auger O.I3. J O + I.D. Y '� <br /> . Completion on-Stove pp (e <br /> ele;one) <br /> Drilling CoMP apy: <br /> eosin - <br /> Drilter' � <br /> wi rrYFinil hr},�."�..qi#Y, <br /> f76 <br /> Geologist .« , <br /> ABOYE-GROUND <br /> CO LETION C R r�Ty-8Ox <br /> t:OMPL_ET1 <br /> CII&PERMIT_INFO. Go rnd <br /> rcS <br /> P ••� <br /> QWA <br /> Distance..to sewer line <br /> Domestic well on site- Pce n <br /> If yes, location and dis <br /> m <br /> SAMPLING stor'Od <br /> Holding Teen erature <br /> Method <br /> Screening Method l f <br /> Tracking Sheet - !n) <br /> 7� x <br /> a....,.�...Il tL <br /> r <br /> SPOILS <br /> Storage Method I MATERI&AMEWLOPMEI I"T. <br /> Contamination Noted n) t'�ti <br /> Storage Location:;S, tjj,,,,L& ^^ Lam - Casing type _. <br /> Blank ft. SctefL <br /> S1ot;size . <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water / d Bags-sand/gravdl <br /> Mix RFilter Pack t oOhla <br /> Installation Method Surge Block: (y;/ <br /> Quattitlr Installed ; .___. Discussed with geologists - I n) <br /> Type of method <br /> EH 29 29 <br />