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1 <br /> NITORING WELL INSTALLATION!REPO <br /> i <br /> d, <br />_ F r <br /> Date: A •3 CONSTRUCTION , <br /> Premise Address: /6Q-3 Total Depth Q2 <br /> Screen Length (from) 1'0 (to) -C-5- <br /> Well <br /> '.5Well No.: Filter Pack (from) QO (to) 61= <br /> I / Bentonite (from) ti's {to) �k ,r l <br /> Inspector: Grout, nevi -aom) �� (to) <br /> Drilling rig type <br /> Permit No. Auger_O.D. 1 << .s y <br /> Completion =`Stove pi christie box ircle one) <br /> Drilling Company: <br /> ;j <br />` Driller: a casing <br />` I he:.ght <br /> Consultant �+�� <br /> Geologist <br /> ABONE-CRCUND CHRLSTY-aax <br /> C01►0LETZN <br /> SPECIAL PERMIT INFO. i t3rounC Suri ca�_maN <br /> Distance to sewer line grant <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ii fL <br /> eft. 7P _ <br /> Yc` <br /> SAMPLING sbrrri C <br /> Holding Tempera a <br /> Method 'y —_ �"W <br /> pack <br /> Screening Method Lguw <br /> 4 Tracking Sheet y n ) <br /> 00 M <br /> SPOILS <br /> Storage Method _3 MATERIALSD� <br /> EVEL0PMENT <br /> Contamination Note4A y .n i} - <br /> �� �, �a <br /> Storage Location Casing e f a� r.. <br /> Blank ft. Screen 2 ft. <br /> Slot size 7�c7 <br /> r GROUTING Bags ceme <br /> Buck ' entonite <br /> i Depth to ovate f Bags's, e <br /> Mix Ratios Filter lack tyg <br /> Installation Method Surge Block: n ) <br /> Quantity Installed Discussed with geologis - {�/ n ) <br /> Type of method <br /> i. EH 29 29 <br />