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MONITORLNG WELL INSTALLATION RM-111d <br /> Oj ..: CONS7RUC7TON <br /> Date: <br /> ?remise Address: Total Dep di K y <br /> + Screen Length (from) (to) <br /> Well : S g s Filter Pack`s (from} (ta)_ <br /> -F S S Bentonite Vii' (fromj CLo} <br /> Inspector. Grout (from) (to) <br /> Drilling rig``type w <br /> Permit No.— Auger 0.0.1 I-D. <br /> ` CAnipletio " - Stove pipe/chr3stie_bog-:(circle one) <br /> Drilling Company ' <br /> t <br /> i Cas i.-119 <br /> Driller. =s� — �-� 11 ;w ► aeLght, <br /> Consultant ` <br /> GeolO L <br /> g _ -� 4 A$CY�-�aAOIIND r 4 CHRMT <br /> G�t"r�!cf30N t` x "Comp =i,CH <br /> vV Tir--v <br /> 'E SPECIAL PERMIT INFO_ a � °'_VO j� �� Ground Sufacs f � <br /> ��- ( i <br /> �- I <br /> � jt4cli <br /> Distance to sewer4ine __ CQ;@ <br /> Domesde well-on site._c'y <br /> if yes, location d dis=ce - ! <br /> 1`i s�-3 s - '` .sl.,► �� '�:� � _ ; _F� -mow <br /> 1 ,- p,,,,1. s• � O ""'rte <br /> SAMPLING rr" �.y. 5$��� 1 $�,l ld it:la rrAd _ a r <br /> '`wranI;M� <br /> Holding Tempe cure a1 p` �;. — " Pack <br /> VI <br /> Method Tk <br /> Screening Method — <br /> Tracking Sheet - (y/ n <br /> 2-0-ILS t,t vi „�rl • S�'�l .� <br /> `^ <br /> /nFVFLOF1 <br /> Storage Ylethod LS °�T �Q ,�� 'TERiALSViENT <br /> F <br /> Contamination Noted- (y/ ) Casing ryPe - <br /> storage Location Black fr- Sween �, <br /> Slot size II <br /> Bags cement <br /> -`- --<GRUUTING- - r�Q n BiiLketseatanite - <br /> Depth to water <br /> Bags sand/gravel <br /> Filter Fack typesizMix Ratiose <br /> nsmHation Mediod =* Surge Block: - C Y/ n ) <br /> ' Quantity Installed Discussed with geologist: - C y/ n) l <br /> L Type of In od ' <br /> EH 29 29 <br />