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MONITORING WELL INSTALLATION R a--e-T <br /> G <br /> ZI ZOD Jy - CONSTRUCTION <br /> 1 <br />� Date: �y (iO) <br /> � ``� <br /> �/ Total Depth "� <br /> Premise Address: ( Steen Length (from) " —Q� g� <br /> 40 Filter Pack (from) _Cto) <br /> j We1�NSo.: ��'l/r^` Bentonite (from) <br /> (J Grour (from) <br /> Inspector. Drilling rig type <br /> Auger O.D. ID. — <br /> Permit No. Complerion - Stov ipe/cnrisde box Cdrde one) r <br /> W .� 1 <br /> Drilling Company— JZ G �x <br /> cas idg, <br /> l T <br /> he <br /> Driller. �✓��,��7QU�l/�-�� T <br /> S <br /> Consultant <br /> ` S l r�pi� �- - <br /> Geologic[ � — /�gCYE+9AWND X <br /> ' gp�5t^!oO <br /> =NAL�j AN £ �.' C_Mp=-,,CN ....._„,. <br /> Grcuc Suiaoa <br /> SPECIAL PERMIT I . _ <br /> NFO - ;• <br /> .. - igrvtt�: <br /> Distance to sewer line. <br /> i Domestic well on site - C Y/ n )- AW <br /> If yes, location and distance <br /> SAMPLING <br /> Holding Temperature <br /> _ <br /> Hol g <br /> Method q _ I <br /> Screening-Method� wOLC(\ <br /> Tracking Sheet - C y/ n) <br /> SPOILS <br /> Ll MATTERIALS/DEVELOPNMNT <br /> i' Storage Method / <br /> 4 Contamination Noted - (y/ n� = p ming type <br /> Storage Location° ,(i Blank ft„ teen <br /> p I Slot size <br /> ulY\ Bags cement <br /> GROUTING n I uckets bentonire <br /> Bags f es <br /> Depth to water j Y Filter Pack typ <br /> size <br /> Mix Ratios Surge Blo <br /> Installation Method Discussed 'ch geolo <br /> i Quantity Installed ,��•b Type o ethod_ , /f <br /> EH 29 29 , <br /> N <br />