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L/ I <br /> 1 r <br /> MONITORING WELL INS REI-. KT <br /> /\L'j bt5�A� C-+i01--i <br /> Date: 2-10 16 CONSTRUCTION� <br /> ?remise Address: Vggq �l`S l S�t Total Depth C/ 3'f <br /> --// Screen Length (from) (to) <br /> Well No.: �(l'" �� (7�S ✓4t&C--F1 - Filter Pack (from) (to) <br /> � ����jj Bentonite (from) (to) <br /> Inspector. (d l< r"I Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger OD. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller. � casiaq <br /> height <br /> Consultant �TG � � <br /> Geologist G�' `^1 r-�j�� <br /> V —Q, <br /> ABCVEv'FCUNO - <br /> G;r,P ETICN Q-nLs !oCX <br /> COMPI= iiCN <br /> SPECIAL PERMIT INFO. Grcuc>j Sir+ �� <br /> Distance to sewer line nO R <br /> Domestic well on site - ( y/ n ) 1 <br /> If yes, location and distance - <br /> a <br /> SAMPLING N�A �btad i a <br /> Holding Temperature <br /> Method _ <br /> Screening Method __ <br /> Tracking Sheet • ( y/ n ) - _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) �{�ti <br /> Storage Location Casing type'ff — <br /> Blank a-S ft. Screen ft <br /> Slot size 0,0 2.v <br /> GROUTING Bags cement <br /> Buckets bentonire <br /> Depth to water~ Bags sand/gravel <br /> MixRados hlR 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 />