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�vITORING WELL INSTALLATION RE <br /> Date: //D�I CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) 1'0 (to) 15'0 <br /> Well No.: 41W -3L - / 70 Filter Pack (from) 1"2 0 (to)�t 2 <br /> Bentonite (from) I tie _(to)_j 38 <br /> Inspector: _ briG� &L1�1��- Grout (from) 138 (to) sa.ce <br /> Drilling rig type_V)00 VU'fii �r+t l <br /> Permit No. Auger O.D. (�. T� I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company:_ <br /> Driller: casing <br /> he�9hi� <br /> Consultant �y� S <br /> Geologist._ ffil9v.Q .. <br /> AYE-GRCUND <br /> OOWLETnN C�G*TY-80X <br /> COMPLE nON <br /> SPECIAL PERMIT INFO. Grand idle, <br /> Distance to sever line 9fcut <br /> Domestic well on site - (y/ n } J33 It, <br /> If yes, location and distance - U2 ft. <br /> a <br /> • C <br /> SAMPLING Nocl <br /> to <br /> � <br /> �. <br /> ecacn <br /> Holding •^,• .� <br /> Temperature = � -Eqs <br /> Method ? _ <br /> Screening Method <br /> Cl <br /> Tracking Sheet - (y/ ri <br /> sporl,s <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type__ fA 501-50 2-" �Y <br /> Blank Fc. Screen _ . <br /> Slot size •D2 <br /> GROUTING Bags cement__ <br /> Buckets bentonite <br /> Depth to Nvater _ Bags sand/gravel ' _ <br /> Viix Ratios _ _ _ Filter Pack type/size 3 Sonn/� <br /> InstalIarion Method __ _ Surge Block: - ( y/n ) e <br /> Quantity Installed•_ _ Discussed with geologist: ( y/ n ) <br /> EH 29 29 <br /> Type of method_. <br /> - <br />