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i � <br /> MONITORING WELL INSTALLATION REP-e-T <br /> Date: �IM�" �� 7 CONSTRUCTION f <br /> l <br /> Premise Address: 2 `� ` VO ODAD Total Depth �/ 1 <br /> �'� ` '3 Steen Length (from) Z ` (to) <br /> Well No.: (�-w i� � Filter Pack (from) 1 (to <br /> Bentonite (from) (to) ��-' <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove ipe/clzristie box (circle one) <br /> Drilling Company. <br /> Driller. <br /> rot. � casing <br /> he; ht: <br /> 7 7 <br /> Consultant / ` C�n .- <br /> Geologist /BCV--GRCIJND <br /> CX <br /> CC&F_i SON COtAP�`!-'CN <br /> CCiNP+..c i CN <br /> SPECIAL PERNUT INFO. <br /> r <br /> n� <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) --`�- <br /> If yes, location and distance - - <br /> A 16 <br /> - - <br /> _ O <br /> SAMPLING JQ vJ storwd <br /> v uJ'L <br /> Holding Temperature <br /> VLiv11 `� M. <br /> Method <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) <br /> :2. ♦ <br /> SPOILS �"' � <br /> Storage Method TERIALS/D OPME <br /> Contamination Noted - (y/ n) ZO �Casing type Storage Location777:.�ZID <br /> Blank ft. Seers ft <br /> r � � <br /> F �1 C Slot size <br /> TI <br /> GROUNG sV J� Bags cement <br /> Buckets bentonite - <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - C y/ n ) <br /> Quantity Installed Discussed with geologist - C y/ n) <br /> Type of method <br /> EH 29 29 <br />