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TM MONITORING WELL INSTAL ON REP,.ttT <br /> � <br /> Date: G 1. L AAWCONSMUCRON <br /> Premise Address: l Total Depth— <br /> "51f. <br /> epth Cit <br /> A 2 y st{ � f !D!P f 17 Screen Length (from? <br /> Well No.: ILIVI _3 "Filter Pack (from) -7�0 _(to)___ �- <br /> y 3^ /Cb (01 4 0 P V` Bearonire (from) LL_ (to) 2 <br /> L-� � alar <br /> Inspector. p, Grout (from) 2- (to) aj Y-4 <br /> 1 0�- �S Drilling rig type 1 <br /> Permit No. S } Anger O D. L.D. �- <br /> Completioa - Stave pipe/christie bog (circle one) <br /> Drilling Company V /,-A,W Lw 2. <br /> Driller. .0 01 casing <br /> Che,.gh <br /> Consultant 10 Ccl C O Q' <br /> Geologist <br /> 1 JlBCVE�^sFaO�1ND CftR � <br /> I A'% Cr"frPL=TfCN CaMPLZ=7CN <br /> SPECIAL PERMIT INFO. `{ Ground Ststaca <br /> .KvJ4 grout <br /> Distance to sewer line <br /> Domestic well on site - y/ n ) ti <br /> If yes, location and dis ce - �,,�1n7 '� B 45 tL <br /> 73 <br /> a , <br /> SAMPLING sfcaad <br /> Tie� wean F=- � <br /> Holding Temperature <br /> Method t C f <br /> e <br /> Screening Method - — <br /> Tracking Sheet a) <br /> SPOILS <br /> �f <br /> r <br /> Storage Method Q �Sc 5 k� . MATERIALS/DEVELOPMENT <br /> Contamination Noted -(Y/ n ) a-{- T <br /> Storage Location ckSr< < 1001 Casing type <br /> Blankft- Screen -fr- <br /> Slot size OIL) <br /> GROUTING {�j Bags cement <br /> f Buckets bentonite <br /> Depth to water b Bags sand/gravel <br /> Mix Ratios Filter Pack tyMr/ <br /> Installation Method Surge Block: n ) 54 rP` <br /> Quantity Installed Discussed wi logist.( ( y]/ n)I� L . <br /> Type of method-0- <br /> { <br /> EH 29 29 <br /> r <br />