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`„dONITORING WELL INSTALLATION REF....xr <br /> Date: Zq-qCONSTRUCTION <br /> 1 <br /> Premise Address:_ PJ . Total Depth <br /> "� Screen Length (from) 7,o (to) <br /> Well No.: d4 A)— �,7. 3 Filter Pack (from) 2-0 (to) 4 <br /> Bentonite (from) q (to) 3 <br /> Inspector. QAO Grout (from) (to) i <br /> Drilling rig type <br /> Permit No. Auger O.D. 4 `f <br /> Drilling Company: 4A) Completion - Stove 00eristie box (circle one) <br /> Driller: p&yc �✓l/dV v/ � casing <br /> ' height <br /> Consultant �&i 4km TZ�fitQ� <br /> -F'W' <br /> Geologist i///j/ 'de'4xf <br /> ABOVE-GACUND CHMM-aoX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. �Acc Grourd Ste + <br /> Distance to sewer line Draft <br /> Domestic well on site - ft/ n) <br /> If yes, location and distance - ft. <br /> SAMPLING tlor.ad <br /> saricn = <br /> Holding Temperature = ptaval F <br /> Method <br /> Screening Method 1 =_ <br /> C.: <br /> Tracking Sheet ( n ) <br /> ft. <br /> SPOILS <br /> Storage Method PJ MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( n ) �� �/ 1 <br /> Storage Location to!L4' Casing type 10 (7 9 <br /> Blank �j-' Screen ft. <br /> Slot size 0 •01h11 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 1 Baggravel <br /> Mix Ratios Filter ck type/size �fQNI) ?i <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />