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MONITORING WELL INSTALLATION Rr }RT <br /> shed <br /> eCJ7 ( t4p <br /> Date: <br /> cc CONSTRUCTION <br /> Premise Address:__ <br /> Well No.• S °m) (to) <br /> c from) <br /> �� . fro <br /> Inspector: (to) <br /> (to) <br /> Drilling rig type C' - t NAO 14 5 <br /> Permit No. 3 Auger O.D. " T.D. <br /> Drilling Company: *C7f�-tknj circle one) <br /> Driller: ! +�!rb (�C a�[.�/-1 C casing <br /> K L e C fl�� EY height <br /> Consultant _._ _. <br /> Geologist �— <br /> ABOVE-GROUND <br /> 00LETCOMPLfiT�ON <br /> ION -BOX <br /> SPECIAL PERMIT INFO. �, �� 1 ) Ground Surfak* <br /> D Sfly <br /> Distance to sewer line 2 5e/12+', C 5 —,1 procrt <br /> Domestic well on site - y n ) l <br /> If yes, locatio}}�� and dis ce - I D. No odGY . <br /> r c+t K LR 0 w✓1 11 i S -ft <br /> f t <br /> SAMPLING U = <br /> (7 as -4do W; _ <br /> Holding Temperatur y<: <br /> Method Val all� <br /> � ` : _ <br /> 5 e <br /> Tracking Sheet - (�' ;n ) :.n <br /> SPOILS ! <br /> Storage Method Lk S MATERIEVELQPMENT <br /> Contamination Noted - (y n <br /> i <br /> Storage Location -� --s � Y e <br /> Screen ft. <br /> GROUTING " <br /> 1 Buckets b <br /> Depth to water I gs s <br /> Mix Ratios <br /> Installation Method ock: <br /> Quantity Installed geo1q.gis . - <br /> II V e of method <br /> EH 29 29 �jt fir` C� <br /> Crete `s <br /> � � G <br />