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sr_� � <br /> MONITORING WELL INN REPORT <br /> Date:J1��'�' CONS C=ON <br /> Premise Address: E• 7 �` `�— �� Tot Depth <br /> Screen Length (from) (to) <br /> Well No.: 1--A^) ( Filter Pack (from) (to) <br /> ' 1 Bentonite (from) (to) <br /> Inspector: �� Grout (from) (to) <br /> �) Drilling rig type <br /> Permit No. M�4 Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant / `Rr_l I <br /> Geologist -- _1ET <br /> ABOVE-GROUND <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. around Staiaga <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - tt. <br /> tt. <br /> -V <br /> Ac• C <br /> O <br /> SAMPLING ato ttQd <br /> �[vL ago n <br /> Holding Temperature 7 <br /> Pack <br /> Method !/off <br /> Screening Method = <br /> Tracking Sheet - jf n ) <br /> tt. L — tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) ,j P� <br /> Storage Location Casing type a <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 7'd"� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />