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.p w <br /> MONITORING WELL INSTALLATION REI-,., <br /> Date: h� CONSTRUCTION <br /> Premise Address: CK d/ I�tl7*�� C( • �`�1 f'��'r Total Depth o <br /> 4 Sween Length (from) (to)-/ •— <br /> Well No.: ��'l/' 3 ,LL _ i� Lu Filter Pack (from) (to) I <br /> 1 I/ Bentonite (front) {to] <br /> Inspector. � Tc A Grout (fro } (to) <br /> Drilling rige <br /> Permit No. Auger O.D. �� LD. z- <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Co740- <br /> any: <br /> Driller. casinrsud- <br /> Distance <br /> height <br /> Consultant <br /> rf�-F- <br /> r <br /> Geologist <br /> ABOVE-GROUND <br /> OOWL MNRLS Y-3OX <br /> MPL-iTClV <br /> SPECIAL PERMIT INFO. Ground to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - A� ' <br /> _r (� �+ tL <br /> SAMPLING rad = C <br /> Holding Temp e <br /> -k — <br /> Method ;? _ <br /> Screening Method »` — <br /> 7racking Sheet - y n ] ` _= . <br /> SPOILS <br /> Storage Methodt✓��-'-'°� S�LCC ]io, MATERiAIS EVELOP?VIENT <br /> Contamination Noted - (y/0) V 1 <br /> Storage Location Casing e <br /> Blank ft Screea h- <br /> Slat size O <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �6 ` Bags sand/gravei <br /> Mix Ratios /' r Filter Pack type/az <br /> Installation MethodSurge Block: - �r)/ n } Q L <br /> Quantity Installed L Discussed with geologist: - / a} <br /> Type of methody <br /> EH 29 29 <br />