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MONITORING WE?.L INSTALLATION aFPVR <br /> U vv <br /> LZRZI <br /> ? CONS"1itUCEON f <br /> Date: <br /> 2 / /j t Total Depth <br /> Premise Address: Screen Length (from) K �3' (to) <br /> 2 1 rater ?ack (from) - (to)—Well No.. Bemmnire (from) (to)_ <br /> Grout (gym) (to) <br /> Inspector. DrMmg ng type <br /> Auger O.D. I.D. <br /> Permit No. � ���( Completion-Stove pipe/christie box (circle one) <br /> Drilling Company. f c '\�r� <br /> �JA <br /> l C331:TQ <br /> Driller. � heiSnL , <br /> Consultant <br /> Geologist -- A3CY`vaCUND �iSY�Cx <br /> CCM?:—c-i rON GrMPL='iC <br /> C�ac:cd Scs:x.� . <br /> gr Ma <br /> Distance to sewer lisle L <br /> Domestic well oa site - ( y/ n ) l a liJ f <br /> If yes, location and distance - <br /> _ s <br /> Holding Te_nperature [� <br /> Merhod z d <br /> Screening Merhod d 1 _ <br /> r,. <br /> Tracking Sheet - (y <br /> SPOMS <br /> f <br /> Storage Method _ v�VAT---R ALS/DEVEL0PN ENT <br /> Contaminarion Noted - (y/ n ) 3 Casing type Sween <br /> Storage Location �e'^ Et. <br /> ._ <br /> Slot size <br /> GR„ CIT�?G C�� Bags cement <br /> i -j2-( Buckem bentonire <br /> \' Depth to water ro �t� <br /> Bags sand/gravel <br /> Mix :Larios Lisare-r Packtype/size <br /> Installation Method ur;e 31ock- - (y/ n ) <br /> Quantity Installed ^� Discrssed with geologist - { y/ n } <br /> Type of mediod <br /> EH 29 29 <br />