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MONITORING WEtd,INSTALLATION REPORT <br /> Date: I L O G l <br /> CONCON=ON <br /> Premise Address:_12 p n C)�4 <br /> Total Depth b0, _ 6y <br /> Well No, rtn t. _ Screen Length (from) y,(q. <br /> Filter Pack (from) <br /> Inspector. L)t r (j(-63 Bentonite. (from), (t°)—(z I .C) <br /> z � , <br /> —�— Grout --_(t°)—� <br /> Permit No. (from)—__—(to)_� <br /> Drilling rig type <br /> Auger O.D. <br /> Drilling ComPanY_ (�J Q S rte_ Completion-- LD. <br /> Stove pipe/ciuistie box (c— irccle�- <br /> Driller. <br /> Consultant /� � �— casing <br /> ��MM/� he±ght <br /> Geologist <br /> A-BCVE-GACUND <br /> SPECIAL PERMIT INFO. OCk'LET)CN CMMacx <br /> cvv-.rd SLrfa v �t-=nCN <br /> Distance to sewer line <br /> Domestic well on sit (y/n ) <br /> If yes, locationa` <br /> distance - <br /> 3Y•6 fr. <br /> °'3 tr. •� n. <br /> SAMPLING = <br /> Holding Temperature Cf�n U riotsd <br /> Method rn ti( soc;cn = 3 <br /> Screenin.- Method <br /> Tracking Sheet - = Cravd <br /> n ) — <br /> SPO `3 R. _ <br /> fT. <br /> Storage Method <br /> Contamination 1 ar� n, <br /> Storage Location ca l Y/n) MATERIAIS/DEyEI OPMENT <br /> Casing type Z Qy� <br /> G;?_O Sloe Blank d 102-0 Screen�_ft. <br /> Depth to water Y el Bags cement, <br /> Mix Ratios Buckets bcntomte_ _ <br /> Installation Bags sand/gravel <br /> Ml Filter Pack c <br /> Quanrity Install —� k tYP /size <br /> Surgc Block: - (y n <br /> EH 29 29 Discussed with geologist: _ (y� <br /> Type OFmethod <br />