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-0*�qNITORING WEU INSTALLATION <br /> if <br /> / I _ I CONSTRUCTION i <br /> Date: i <br /> IS S E � o /dD® 5 �` Total Depth <br /> Premise Address: ' I Screen Length Cfrom) ' Y t CO) 1 '7- <br /> Filtet Pack (from) 2 (to) vc: ' <br /> Well No. : <br /> yl W aI v owlNIW G — Bentonite " (from) 2 / (to)7 FT <br /> •Cto)_ 21 <br /> 0184 h/ Grout Cfrom) d • J <br /> Inspector: Drilling rig type I"1 <br /> �/ X089 Auger O.D. 2 I.D. <br /> permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: N 13 �9A/ <br /> casing <br /> Driller: jeDB $ 7 ! L )q&96 L height <br /> consultantL. y <br /> 1 <br /> Geologist 3JjIN /Et !/I!a! kNkC�— ABOVE-GROUND 15 i4= <br /> CDNPLETION C PLEfiON S <br /> C3rwrd Surlxe <br /> SPECIAL PERMIT INFO . <br /> proof <br /> Distance to sewer line <br /> If yes, location and distance - 2 j ft <br /> _ — <br /> SAMPLING • yac5on — <br /> �`'N pack <br /> Temperature <br /> = <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( Y / n ) tt 5' tt — �/ it <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - ( y / n ) Casing typ e <br /> Storage Location Bl 2 _ft. Screen � S ft• <br /> Slot size d• o 0 <br /> Bags cement <br /> GROUMNG Buckets bentonite ( 8 <br /> Bagssand/gravel 7' 9 `� LB� <br /> Depth to water Filter pack type//siize <br /> Mix Ratios _Surge lock: <br /> Installation Method Discussed with geologist: - 09/ n <br /> Quantify Installed . Type of method <br /> • - i <br /> EH 29 29 <br />