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-,_ nONITORING WELL INSTALLATION Rta� <br /> Date: QQN01UCTION <br /> !Vy <br /> Premise Address-.-W?/ Total Depth <br /> �I -� 7 (to) <br /> Screen Length (from) <br /> Well No.: GQ W Z' Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: 092:5!� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. D3 Auger O.D. 17 I.D. " <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> Consultant <br /> +C T height <br /> Geologist Ac'''v` T <br /> ABOVE-GROUND CNFilS1Y�OX <br /> 0OWLE'TiON <br /> ESPECIAL_PERMIT_INFQ, Ground <br /> Distance to sewer line 6`14— fns <br /> Domestic well on site - y/ ky - fl <br /> If yes, location and dis e - � M <br /> ILM _ <br /> - <br /> �� o <br /> 7]p <br /> SAMPLING <br /> � ��Cd"• sedcn 3 <br /> Holding Te perature <br /> Method Pack <br /> Screening Method M, <br /> Tracking Sheet y n) <br /> SPO <br /> Storage Method hMMR1ALS/DEVELOPMEN'l <br /> Contamination Noted - y ;Lo <br /> — <br /> Blank <br /> Location ming type. - — <br /> Blank ft. Screen ft. <br /> Slot size ' 010 <br /> GROUTING Bags cementIq <br /> i <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 6 <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - n) <br /> Type of method <br /> EH 29 29 <br />