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y, ONITORING WELT.INSTALLATION RE=.OtT <br /> Date: CONSTRUCTION <br /> Premise Address: c Total Depth , <br /> Screen Length [from) (to) <br /> Well No.: Filter Pack (from) <br /> Lw._3 Bentonite (from) <br /> Inspector. t (from) <br /> ) (to) <br /> Permit No. <br /> �� �� Drilling rig type <br /> Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: � c.✓►. S LAI/)-f., <br /> Driller: C> r I �1'c�.r., �+� <br /> ...�.._ casing <br /> Consultant height <br /> Geologist <br /> A CVE-GRCUND <br /> CC NV LETfCN =STY-30X <br /> SPECIAL PERMIT INFO C>AP EnCN <br /> C3rvc:nd 5irfx* <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> if yes, location and distance <br /> 0 <br /> +: o <br /> SAMPLING C <br /> _ O <br /> socicri <br /> 3IOroi c <br /> Holding Temperature r <br /> Method <br /> Screening Method <br /> Tracking Shcet - (y/ n ) ;r <br /> SPOILS <br /> WJE 44 ery e- P r�2�, -lam ��( w` <br /> Storage Method MATF.PJALS EVEI,OPMENT <br /> Contamination Noted - <br /> Storage Location Casing type <br /> Blank ft- Screen fr. <br /> GRQU?T1NG Slot size <br /> Bags cement ( - <br /> Depth to water Buckets bentonite U 11 <br /> Mix Ratios Bags sand/gravel <br /> f Z Sc� <br /> Installation Method Surge Block: - [ /Filter Pack type/size n ) <br /> Quantity Installed y <br /> Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />