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f <br /> MONITORING WELL INSTALLATION REF---,tl <br /> OLCON0( <br /> V - '_ <br /> STRUCTION <br /> Date: <br /> { f G4 Total Depth <br /> ?remise Address: �� '" <br /> -A <br /> Screen Length (from) 59 (to) 5 <br /> (' Filter Pack (from) (to) <br /> Well No.: Ya - Bentonite (from)____51-'S _ (to) <br /> l�"'�' t° '� Grout (from) ! (to) <br /> inspector: Drilling rigtype GIwL` <br /> Auger O.D. I.D. I2.ZS <br /> ?ermit No. �jCompletion - Stove pipe/cnristie box (circle one) <br /> Drilling Company:_ �(' — <br /> casing <br /> Driller: ♦ ` �� height <br /> l�V <br /> Consultant <br /> Geologist ASC'I-wAOUNO , ,oCX <br /> =TAN C;}MPI=iiCN <br /> Grnc:nd S�sfr+ ; <br /> SPECIAL PERMIT INFO. <br /> � ?rout <br /> Distance to sewer line <br /> Domestic well on site ( y n 2 S �- <br /> f,yes, Location and distance - <br /> LL <br /> o � <br /> sAA,IPLING 44K :totted - <br /> �. <br /> _ <br /> Hold ng Temp nature AJO Cod <br /> Method <br /> Screening Method <br /> racking Sheet ( Y/ n).. -- <br /> O <br /> SPOILS <br /> Storage Method MATF_.R1ALS/DEVELOP?�NT <br /> i/ <br /> Contamination Ne - n ) <br /> �� Casing type <br /> Storage Locationot ` -�1^^ e- BlankC fr. Screen <br /> Slot size •0 `"� <br /> 41 Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel��,.-,�, <br /> Depth to water Filter Pack type/size <br /> Mix Ratios 5 d Surge Block - C y/ n ) <br /> Block- <br /> installation Method 's Discussed with geologist. - C y/ n) <br /> Quantity Installed t Type o method <br /> EF 29 29 ry <br /> Ak r <br /> f ( �� f <br /> y _ , <br /> y ra Ia t�;�� J �J,l(g��o ..�- �'°�11r• ��' tv l�� ��'_ `��-� fr 1 a�-�.S �.�fc �Q , ,.���m <br />