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MONITORING WELL.tr*'r•— <br /> „� - <br /> LINSTW,�,RON PVORT <br /> MONITO�NG' �' <br /> CONSTRU�ON <br /> 6L Total Depth <br /> Date: � (fr <br /> Screen Length <br /> Filter Pack <br /> PremiseAddr'e�ss_: " 1 « JI`d Bentonite (from) <br /> Well NO.' <br /> Grout <br /> Drilling rig type Y.D. <br /> Inspector: Auger i c/az-stie box (circle one) <br /> Completion -Stove p p <br /> Permit No- <br /> * casing <br /> Drilling he;ght <br /> c Driller' _ ei <br /> D Consultant 4�qyE-GRCt.1NO C,i��.80X <br /> D COMPLETION GOMPt-- ICN <br /> If Geologist G=nd 5LXf act <br /> SPECIAL PERMIT INFO• <br /> Distance to sewer line / n) )J � � ft. <br /> SM Domestic well on site - (Y �p k Ix ft. <br /> --` If yes, location and distance <br /> v <br /> Hol( ;... <br /> 0 <br /> Metl ' • o <br /> Scre, <br /> Tract t: <br /> cicrpi n <br /> S�G smv-SA Pack <br /> EPOII Holding Temperature r �_ <br /> Method A <br /> Stora � <br /> Screening Method ft. <br /> Contac Tracking Shcet - (Y/ n <br /> Storag <br /> GROU1 SPOILS_ MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Depth t Contamination Noted - (Y/ n) Casing We ft. Screen -----�— <br /> Mix Rat Storage Location Blank <br /> lnstallat Slot size <br /> Quantity Hags cement <br /> GR USING Buckets bentonite <br /> EH 29 2, Bags sand/gravcl <br /> Filter Pack <br /> Depth to water <br /> type/size <br /> Mix Ratios gorge 131ock: - �/ n) <br /> Installation Method Discussed with geolo i 2 �/ n 1 <br /> Quantity Installed Type of rncdiod -Q A' <br />