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+ y YnTSI_ITORING WELL INST'ALLAT'ION REPOx y } <br /> IJ <br /> f}Date: CONSTRUCTION x ` <br /> / -� / <br /> Premise Address: : /��SKS// ! •''' . ;Total Depth �3 <br /> !0 U cr S'a <br />! Well No.: 3y [T/ ( r Filter Pack (from) /0. (to)Screen Length (from) (to) <br /> 8 <br /> ri i 9- Bentonite (from) —(to) Co <br /> Inspector: Grout (from) 'T <br /> (to) 3 <br /> L K r Drilling rig type <br /> Permit No. .N 4 1 w - <Auger O.D. tS' - -i I.D. <br /> y3µ LL Completion -Stove pipe/chiistie box (circle ohe) <br /> Drilling Con{-.j)any: '.14�61 <br /> 14 <br /> /j4 <br /> y <br /> it / ULG/ `�/Y/N�� / casing <br /> d. Driller: � <br /> i IffT <br /> height <br /> Consultant 1vG-9 Mq, ' <br /> T <br /> 11, Geologist 91. - x <br /> ;,.. .ABOVE-GROUND CNAISTY-80X <br /> COMPLETION COMPLETI - <br /> Ground Surface <br /> SPECIAL PERMIT INFO. <br /> r" .1 " �, •�r- a uas = �. grout <br /> Distance to sewer line s <br /> Domestic well on site - ( y/ n ) ;'' 1 6 n• <br /> n If yes, location and distance - .. ft ### <br /> 2 — - .. . .. <br /> Al <br /> SAMPLING <br /> slotted — $ <br /> secdon <br /> Holding Temperature /` gm�� <br /> Method <br /> a — <br /> Screening Method N A <br /> Tracking Sheet - (y n <br /> Ift. t <br /> j SPOILS <br /> Storage Method .MATE=RIALS EVELOPMENT (! <br /> Contamination Noted - ) "'.' Yi <br /> Storage Location 'Casing type-' <br /> Blank_ ft. Screen 3D n AU ft. <br /> aw n Slot size •n�J n ! <br /> GROUTING r' Bags cement <br /> M.. - <br /> w Buckets bentonite <br /> Depth to water ? 4,' _ Bags sand/gravel <br />\In <br /> os Filter Pack type/size Z !b + <br /> tion Method Surge Block: - (y/n ) i} <br /> y Installed "" Discussed with geologist: - (y/nType of method <br /> 9 <br /> . v <br />