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MONITORING WELL INSTALLATION RtVLP1..-T <br /> Date: CONSTRUCTION j <br /> ?remise Address: r# t `J . Total Depth <br /> , 11 Screen Length (from) .:,' (to) 6 f� <br /> Well No.: r� W Filter Pack (from) .4 (to) <br /> Bentonite (from) -5-9- (to) !-L . <br /> Inspector. V" Grout (from) (to) <br /> Drilling rig type M ;)-e -6 <br /> Permit No. o 203 Auger O.D. _ I.D. Li <br /> Drilling Company: CI <br /> _ Completion - Stove pipe/chrisde box circle one) <br /> C1 <br /> ��� <br /> Driller. ti;— ce;ght <br /> height <br /> Consultant C i m -�- <br /> Geologist �7 <br /> /lBCVr-GRCUNDA <br /> CHRp+T-aCN <br /> SPECIAL PERMIT INFO. 1 Cued Surface <br /> Distance to sewer line �{QO' s1 <br /> grout <br /> Domestic well on site - (y Val � c(�! <br /> If yes, location and distance - n n IL <br /> a <br /> SAMPLING © I51 C0.cGll ciQd = <br /> g.� C. - <br /> Holding Temperature ' _ gmvw Pack <br /> S M --- -- �' <br /> Method <br /> Screening Merhod Q . � r1 A- '")d r �^ <br /> _ I <br /> Tracking Sheer - C Y/ nrL) <br /> .-M n <br /> -•-- <br /> SPOILS <br /> a Method MATERIALS/DEVELOPMENT <br /> Stora g <br /> Contamination Noted - (y/ n) �� Casing e IF VC <br /> Storage Location ^; 30 � Blank Seen ` S ft. <br /> —�— Slot size C)?D <br /> J � <br /> GROUTING Bags cement _ <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to war Filter Pack typesize 1 - <br /> Mix Ratios �\ Sorge Block. - (Y/ n)J <br /> installation Method Discussed with geo n - C Y/n) <br /> Quantity Installed Type of method <br /> — <br /> EH <br /> / - <br /> EH 29 29 / �� /I <br /> eJo ►� Rei ks ;� <br />