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MONITORING WELL INSTALLATIC'd REI..e-T <br /> Date: n 0-3 CONSTRUCTION <br /> Premise Address: 1 �i1 v�-1 Total Depth <br /> M 1 Screen Length Cfrom) SCto) <br /> Well No.: Filter Pack (from) (to) g� <br /> Bentonite (from) (to) 6 3 <br /> Inspector. V © N v' Grout (from) (to) <br /> Drilling rig CYP <br /> Permit No. <br /> !a(�� Auger OD. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: I*� ` <br /> Driller. casing <br /> F71 <br /> he; <br /> Consultant <br /> Geologist � � llBCVEv'RCx1Nb <br /> C,'CWLEMON CMPL -30X <br /> COMPtcTiCN <br /> SPECIAL PERMIT INFO. K7 �(� G"nd SLrf� T-- <br /> C � <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) CL T `t <br /> If yes, location and distance - tL <br /> iL <br /> J — 3 <br /> 5-0 <br /> SAN(PLING —� j�n _- <br /> �S D _ <br /> Holding Temperature cC� ��- [ _ ¢avvi <br /> Method E D <br /> Screening Method _ — <br /> Tracking Sheet - C y/ n ) 3- _ <br /> SPOILS � � . <br /> Storage Method rip MATERIALS/DEVELO MENT <br /> Contamination Noted - (y/ n) _ <br /> g ^ / <br /> Co tame Location �� Casing type v <br /> Blank fr- Screen ft. <br /> Slot size <br /> GROUTING ( Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/�avel <br /> Mix Ratios Filter Pack typ <br /> Installation Merhod Surge Block - y n ) <br /> Quantity Installed Discussed with geologist: - ( n) <br /> Type of method <br /> EH 29 29 5�I I [ / <br /> qO <br />