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MONITORING WELL INSTALLATION Ajaf <br /> i� <br /> i - LV.01.14, Soc7��r�t sk Ic). <br /> Date: v CONST'RU=ON <br /> Premise Address: ?7� YS�K Total Depth /q <br /> d <br /> �/ Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> F Bentonite (from) (to) <br /> Inspector. 14664 Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. /0 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Compan <br /> s <br /> Driller:__ � ` ' casing <br /> height <br /> Consultant <br /> Geologist o <br /> ABOVE-GRCUND C�•ASiY- X <br /> CXJAi'L_�ffON OO {PLEMN <br /> SPECIAL PERMIT INFO. Ground S <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - h, <br /> ft. <br /> _ - o <br /> — o <br /> — o <br /> SAMPLING clot ni _ c <br /> Holding Temperature = tzavd;z�c <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> n, <br /> SPOILS <br /> Storage Method MATERIALS/DEVtEI.OPMcNT <br /> Contamination Noted - (y/n) _ <br /> Storage Location Blank type fr. Screen —f <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> MU Ratiosr Filter Pack type/size <br /> dAstalladon Method Surge Block: - (y/n) <br /> Quantity InstalledDiscussed with geologist: - (y/ n) <br /> Type ofnethod <br /> OyJ 6,446 <br /> EH 29 29. 6S 1 <br />