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i 1, ! <br /> MONITORING WELL INSTALLATION REP-KT <br /> Date: CONSTRUCTION <br /> ?remise Address: C) 't. Total Depth <br /> /� - Screen Length (from)—�-(to) <br /> Well No.: / ' VJ Filter Pack (from) 1 (to) <br /> A '/ Benronite (from) (to) �R <br /> Inspector. 1 A7 D 10 L-) Grout (from) (to) <br /> Drilling rig type <br /> Permit No. <br /> Auger OD. [.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: I v 1 ►1 '� <br /> casing <br /> Driller. heLghc <br /> �� r • + <br /> Consultant j� <br /> Geologist `� �'� - A3CVE-GACUNO \ \ { <br /> t�+AtST'!-30X <br /> CCW Er.CN COMPL-:TCN <br /> SLrf <br /> SPECIAL PERMIT INFO. � acs T-- <br /> i <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - d (� —� k- <br /> 30 C( � T _ <br /> ` — s <br /> Tf 5T/C-L I - <br /> may. 'Ion <br /> SAMPLING <br /> S�� wccn <br /> Holding Tempera=�l 4 _ 72val PCX <br /> Method <br /> Screening Method = <br /> Tracking Sheet - n ) S7 /C <br /> SPOILS <br /> Storage Method z MATERIAIS/DEVELOPMENT <br /> Contamination Noted - (y n) Casing type Q�C <br /> Storage Location 10 Blank_ _ft Screen —rr- <br /> (S for size <br /> GROUTING S Bags cement <br /> - SxBuckets bentonite <br /> Depth to water �I{`"�' �U Bags sand/gravel <br /> Mix Ratios 64� FIlter Pack typ e <br /> Installation Method k1 surge Block - C y n ) <br /> 3fl 3 <br /> Quantity Install d f 3 iscussed with logisc - n) <br /> �� I I l / � Type of method <br /> oro <br />