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MONITORING WELL INSTAU ATION RE-• KT <br /> CONS'CRU=ON <br /> Date: <br /> GU lU• C � �.�c�-✓f/Pr� Z�`/tL4N�� W*�f� Se('l�fnr�r�v C <br /> J I'cr <br /> Premise Address: Total i7epth <br /> Screen Length (from) 1 (to) 2� <br /> Well No.: Filter Pack (from) S -(to) /7 <br /> Bentonite (from) (to) <br /> Inspector �G Grout (from) (to) <br /> S�G7 � �7' Drilling rig tY€�e. M� --- <br /> Permit No. G Auger O_D_ L.D. <br /> Completion - Stove pipe/ tie box (circle one) <br /> Drilling Company: / <br /> "ey4'w/ MTcasing <br /> Driller. T sleight <br /> Consultant_ <br /> lal�iL`Jl�l�h��ir �y Y 7 <br /> Geologist UG r AZCVE;ACUNO <br /> SPECIAL, PErRMT INFO. <br /> grant <br /> Distance to sewer line <br /> Domestic well on site - ( y `t- <br /> [f yes, location and distance - - <br /> ti_ <br /> ✓ifLJ U' i- <br /> 7f hw-6 /S'- hl <br /> 2!/f—�!/`� �`��, d� �/sfl•y. fQr.+r�c� S/�Llkyr'l '�.� _ a <br /> SAMPLING 25-- <br /> Holding Temperature ,11 ,k�,�4k � <br /> Method = <br /> Screening Method ' _ <br /> Tracking Sheet - C y/ n ) <br /> SPOILS ML✓9 c�• •zu1 v� <br /> Storage Method MATERLALS/DEVELOPNENT <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location Blank ft. Screen_----h <br /> Slot size <br /> Bags cement <br /> GREG <br /> Buckets bentonit <br /> Bags sand/grav 'z" a Ili 3 <br /> Depth to water Filter Pack typesize <br /> Mix Ratios Surge Block: - (y/ n } <br /> [nstailation Method Discussed with geologist: - C y <br /> Quantity Installed Type of method <br /> EH 29 29 t� � � fi !'c <br />