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NITORING WELL WSTALLVnON REPO x <br /> +r'ycti <br /> Date: CONSTRUCnON <br /> Premise Address: Total Depth S <br /> Screen Length (from) '-a S (to) is <br /> Well No.: Filter Pack (from) 3:�2 (to) 3 <br /> _ Bentonite (from) T (to) <br /> Inspector: Grout (froth) (to)� <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) i <br /> Drilling Company:, <br /> Driller. � -:F <br /> casfrsq <br /> T height <br /> Consultants LS <br /> Geologist ke( f <br /> 7/4 -EWT <br /> ASCU .GRCUNG CHRZTY-WX <br /> W OOArPL�RfON CCMPI--WnCN <br /> SPECIAL PERMIT INFO. grCOA <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) �_„% <br /> If yes, Iocation and distance - fL <br /> iW ^ M <br /> SAMPLING slam.! <br /> Holding Temperature = gsvol pack <br /> Method <br /> • Screening Method <br /> Tracking Sheet • (y/ n} <br /> �..tt. ........., ':� 7 _fL <br /> SPOILS _ <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) 2 r/ <br /> Storage Location ming type <br /> Blank _ 15 ft. Screen Z2. h. 1 <br /> A _ _ Slot size D <br /> GROLMNG Bags cement <br /> Buckets bentonite <br /> Depth to water_5 - - Bags sand/gravel J-4 000 !b 60`& <br /> Mix Rados Filter Pack type/size <br /> Installation Method Surge Block: - ((I/ n ) <br /> Quantity Installed Discussed,with geologist- - ( y/ n) <br /> Type of method <br /> EH 29 29 Q, <br /> KX g' C- <br /> pro' 3 Ppm <br /> 2D' G ppm <br /> ,act o <br /> I <br />