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MONITORING WELL INSTALLATION REP-e-T <br /> � ( LCONSTRUCTIONDate: 0,11 <br /> SZQTotal Depth ��IIJJ <br /> Premise Address: Steen Length (from) (Lo) <br /> C[o} <br /> Filter Pack (from) <br /> Well No.: /�l(j (. ` Bentonite (from) (CO) <br /> � U�J � Grout (from) (to) <br /> inspector. / Drilling rig type <br /> Auger O.D.-- [D. <br /> Permit No. �p Completion - Stove Pipe/chnstle box (circle one) <br /> Drilling Company. k ' <br /> casing <br /> Driller. Wv C he;ight <br /> Consultant <br /> AiC <br /> _ <br /> logist �D 0 n « � VE—ROUND tS-1 1-30X <br /> lC, <br /> l��� l CION COAAPU—: CN <br /> ! ��� ,Y� � 1, �-C//t� C�'1 Ground S+rhu <br /> SPECIAL PER INFO 111 <br /> orwc <br /> Distance to sewer lme p �_'t <br /> e- on site - (y/ n ) <br /> if yes, location and distance - —_R T--- <br /> 73 <br /> n vz7 0 <br /> �y X16 S docrnd _ a <br /> SAMPLING � ` o o &ec:o <br /> "pacx <br /> Holding Temperature F, _ = '� <br /> Method L' _ <br /> Screening Method _n <br /> Tracking Sheet - ( y/ n ) = tt <br /> SPOILS 1 C � <br /> /DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location Blank fc Screen----------'L <br /> slat <br /> creen —fr- <br /> Slot size <br /> Bags cement <br /> GROUTING n Buckets bentonite <br /> '^JV Bags sand/gavel <br /> Depth to water Filter Pack typesize <br /> Mix Ratios— Surge Block: - C y/ n ) <br /> Installation Method Discussed with geologist: - (y/ a) <br /> Quantity Installed Type of method <br /> EH 29 29 ht <br /> l ��' <br />