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- MONITORINGWELL INSTALL AT ON RE°ORT <br /> rr s le /t/1` <br /> �1CONS _ <br /> Date:_.76 <br /> ZS <br /> Total Depth IL5- LYS Cto) 90 'fR' <br /> Premise Address: %JI Iv Iv Screen Length Cfrom) /�S%j (CO) <br /> �T �� Filter Pack (from) — <br /> I Bentonite (from) ir3. 90 ` (to) 7b-7s' <br /> Well No: /Grout (from) 7S <br /> Inspector. 1�L Drilling rig type LD. <br /> D ©O/'��9 Auger P.D. <br /> Permit No. K ` 00 Completion - Stove pipe/cbristle box (circle one) <br /> V k) /C//�"/(" <br /> Drilling Company cas Lng <br /> Driller: <br /> U!/lettiT $ <br /> Consultant r / <br /> Geologist \7tc AEOVEC'RCUND <br /> CONPLEnON GompLci1CN <br /> G�� VS>r (Su'yllr� -- GfxrxlStztan � <br /> SPECIAL PERMIT INFO. Ye/ d 1 w f� Qrcut <br /> -ia ✓r T. <br /> lt. <br /> Distance to sewer line ft <br /> Domestic well on site . (y/ n) <br /> If yes, location and distance - ft. <br /> J _ <br /> C <br /> a <br /> C <br /> flol:Aj �_ <br /> SLO LING SOClefl <br /> .r — SY3Y9t(2Ot <br /> Holding Temperature <br /> Method —_ <br /> Scree nin;Method = tt, <br /> Tracking Sheet - (Y1 n) ,ft. <br /> Q <br /> SPOILS <br /> M/A/TERJIA[S LO MENT <br /> Storage Method `'�S`� <br /> Contamination Noted- (Y/ n) Casing type Screen_---- <br /> slot lank <br /> Location �� <br /> Slot size <br /> Bags cement <br /> GROLMNG <br /> Buckets gssa bentonite <br /> Bags sand/gravcl <br /> Filter Pack type/size <br /> Depth to Nater Surge Block: - (Y/n) <br /> Mi:t Ratios <br /> �istallation Method Discussed with geologist: - (y/ n <br /> Quantityitutalled Type of rnctliod <br /> 5Z -G-T-lq bP 're le .o5 s fr � <br /> j <br /> EH-2929- <br /> j ' p ���ritlli <br />