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• A <br /> MONITORING WELL INSTALLATION REI-. ?-T <br /> �e l op �IQ <br /> 4Q5•� 49' Vd,,,l <br /> q G710 64 Fence Rx <br /> CONSTRUCTION <br /> Date: / T <br /> 1'1 �Y O n a ro :w<i <br /> ( �uV�(� Total Depth OaMlsfE <br /> Premise Address: � �I to 30 e� <br /> C �_ I M W Screen Length (from) U ( ) o� <br /> Filter Pack (from) (to) P+ <br /> Well No.: ^ 1l Bentonite (from) 9-� . � (to) 74. 6 <br /> 5 � - Q'"� Grout (from)�T-(to) <br /> Inspector: (( Drilling rig type <br /> O 3 b Auger <br /> Permit No. Completion- Stove pipe/christie box (circle one) <br /> `r R <br /> Drilling Company: " `"` W <br /> i I casing <br /> Driller: rr� � � � � height <br /> Consultant `� D A �.L T <br /> Geologist_ V t c -ky ��NO HMp�ox <br /> OckPGround Surface <br /> SPECIPi PES�• <br /> - proof <br /> Distance to sewer line `...._ ft_ <br /> Domestic well on site - / n) L 2 8 ft <br /> cl <br /> If yes, location anddistance - <br /> N S0� ko <br /> SAMPLING �S sectio <br /> aacion <br /> � 70 _• r+vbader " _ <br /> Holding Temperature <br /> Method fN—d- r 2 Z <br /> Screening Method � — <br /> Tracking Sheet - (y/ n) 4 smt�s s+ra ,cL <br /> SPOILS <br /> Storage Method <br /> u` TERIAIS/DEVELOPMENT <br /> Contamination Noted- y/ n) 0.S ,c 44 vp 1 z Casing type <br /> Stora a Location Blank 3U ft. Screen h <br /> o re c' � 2n rgo Slot size <br /> � Bags� Ba cement <br /> GROUTING Q Buckets bentonite— —(iO —_ <br /> 3w Bags sand/gravel CarQSta <br /> Depth to water / bti� Filter Pack type sze <br /> Mix Ratios S1 1 Z 0 Surge Block: -(Y/ n) <br /> Installation Method fyQn mi s _Discussed with geologist•. - n) <br /> Quantity Installed Type of methodEH <br /> 12 29 &+0 VO'c- <br /> IC A� .4 6Wro v19(A� <br /> �T , +W- kgL ;6(r,16� <br /> W Air �.�" -" 11<�cAJ Ci <br />