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�.. el ,. <br /> MONITORING WELL.INSTALLATION REF-v:iT <br /> / Z ` <br /> Date: '� ( c` CONSTRUCTION�7 CONSTRUCTION <br /> 'Ct <br /> ?remise Address: <br /> CJS ZOfJ Total Depth /`' C� oD <br /> �^ ID01 Screen Length (from) (to) <br /> Well No.: l C Z � � � Filter pack (from) (to) <br /> �- Bentonite (from) (to) <br /> Inspector: C�1.3 Grout (" om) (to) <br /> �( Drilling rig type <br /> Permit No. (� AugerO.D. I.D. <br /> r Completion - Stove pip tie box (circle one) <br /> ��� <br /> Drilling Company: <br /> f/ casing <br /> Driller. , � hei.ghr_ <br /> Consultant <br /> Geologist �L �� <br /> I ASC,`1�vRIXJND C}1A4S^!-oOX <br /> C`„tV ��1'zN C--*AP��i,CN <br /> SPECIAL ?ERMT INFO. ( Serf <br /> 2f Oct <br /> Distance to sewer line NAM->"%51 <br /> Domestic well on site ( y—/ n ) <br /> If yes, location and distance at` *Q"4 't_ <br /> m.1or v'.Sh <br /> SAMPLING j l� Ocldr! r crp\ =►octsd <br /> �r 5 110 <br /> Holding Temperature :- <br /> -� =l <br /> :Method <br /> Screening ,Method <br /> Tracking Sheet ( y/ n ) 1, <br /> SPOILS <br /> Storage ?Method w � LVATT-71UALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) C�1�L t"� <br /> Storage Location Casing type <br /> Blank_ ft- Steen ft- <br /> �S� Slot size — <br /> GROLMNG Bags cement <br /> Buckets bentonite <br /> Depth to water L Bags sand/gravel <br /> Mix Ratios ��r� 4DFater Pack type/size <br /> Installation Method Sve Surge Block - ( y/ n } <br /> Quantity Installed Dur-issed with geologist y <br /> - ( <br /> ly Y\ 5 Type of method <br /> EH 29 29 ' koqO C' <br /> -f�l�� ►'� r� D GII�'�U` <br /> MAT C; C MTOL4 <br />