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moNITORING waL FNSTAL.LATION?tEF-.,sCT <br /> r <br /> Date: Q "�✓ 2ao CONSTRUC ON i <br /> ` Premise Address:— (tk, T _ Total ]eprh` Z3 <br /> Screen Length (from) 17 (to} 1E <br /> Well No.: : � " 1� - — Filter Pack (from) v (to) <br /> Bentonite (from) (to) <br /> Inspector: - _r -Grout (from) (to) <br /> :Drilling rig type <br /> Permit No. __ Auge-*O-D. <br /> -Completion - Stove pipe/christie box (circle one) ! <br /> Drilling Company: <br /> r� <br /> Driller. Vr. i _.- cas isr, . <br /> aeighr- <br /> Consultant 7 <br /> S aw } <br /> Geologist — ` <br /> �+ ouS VE-SROUND <br /> 1Ja�Qi�p�r Ioj CC&PLEMON C_ -i�CN <br /> Cu -('� c� Gro nd Strfaca <br /> SPECIAL PERMIT INFO. <br /> r ` <br /> wY Distance to sewer line <br /> Domestic well on site - y n ) CQ ,�- <br /> [f yes, location and dis ce - <br /> f S,4MPLiNG :totted <br /> wc.cn <br /> HoIding Temperature _ �""°�►' <br /> i -Method <br /> Screening Method <br /> Tracking Sheet - ( y MA_LFIN -1 <br /> w � <br /> ` SPOILS <br /> MATMk AM/DfiUELOPMENT <br /> Storage Method � , , P✓ - SG I_ �� <br /> Contamination Noted - (Y/ n) 7 �"�' Casing type '\ <br /> ' Storage Location r�lank [�t- oN creen ft' <br /> ..Slat size . 01 <br /> Bags cement } <br /> GREG Q� S .. ;,iBuckers bentonite <br /> Bags sand/gravel <br /> Depth to water r Filter Pack type/ e <br /> Mix Rados n ) <br /> -� Surge Block: - Y <br /> Installation Method �ti N Discussed with eulogist <br /> Quantity Installed Type of m3 od <br /> EH 29 29 ' <br /> Cq, O <br />