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�.MNITORING Vi=INSTALLATION MM%d <br /> Date: CO <br /> Premise Address• � Total Depth --- <br /> Screen Length (from) 1� _-(to)_ <br /> Well No.: r Filter past (from)_,._(to)f2....� <br /> Bentonite (from) (to) <br /> Inspecoor ; !//2 S _ �, ;.. ..'_ Grout (front) (to) .� <br /> Drilii�S'rig type 7 <br /> Permit No. Auger O.D. LD. <br /> ` <br /> Completion- tove pipe/christie box (circle one) <br /> Drilling Company: ,� � . <br /> Driller: cawing <br /> I . T height <br /> Consultant <br /> Geologist � M <br /> A�av C ND aux . <br /> OOIrPLEMN COMPl:UM <br /> SPECIAL PERMIT INFO. GarvaU d Suiacs . <br /> Distance to sewer line WGIA <br /> Domestic well on site- (y/n) <br /> If yrs, location and distance- it <br /> a <br /> SAMPLING •!a6d <br /> H9Iding Tem <br /> Method •'� '"` .=. <br /> Screening ediod _ <br /> Tracking Shcet y n) i <br /> Storage Method ,iATERIAis/DEVEGQPMENT <br /> Contamination Noted-:(y t! <br /> Storage Location- AU..._ it ..�., ming type <br /> Blank & Screen 1 L <br /> Slot size ©-Z 0 <br /> MOM : Bags cement <br /> l Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size- <br /> installation Method Surge Block: - (y <br /> Quantity Installed Discussed with gco ogist: - <br /> Type of method <br /> EH 29 29 <br />