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y <br /> r �PdNITORlNG WELL INSTALLATION R oh., <br /> Dates o STRUCTION (B-1I <br /> Premise Address:_ 1`1 DO W h)Q Total Depth <br /> / r <br /> Bentonite (from) (to) <br /> Inspector: „.,, . S Grout (from) 490 (to)--�E '' <br /> Drilling rib <br /> Permit No. Auger O.D.. I.D. <br /> r_p }��� K Completion-Stove pipe%hristie box (circle one) <br /> Drilling Compan - L-1Q?ii w <br /> DrMer: Robet-f OrfG VL' <br /> casi.nq <br /> Con:trltaat S v <br /> T height <br />� Geologist 1. <br /> ABGN -GRCUND <br /> CGWLETION COMPLEMN <br /> Qc+aurd S�siaea <br /> r • <br /> Distance to rawer line <br /> io <br /> Domestic well on site - y fL <br /> ifyes;-locatlate and dis <br /> 10 <br /> soccn ." <br /> Wft nod"TIM, 4 � UQ.a <br /> padt <br /> .r <br /> i <br /> insi od <br /> Wracking Sheet - (y/n <br /> Storage;Method S MA,�'E� tIALSMEVELOPMENT <br /> Contamination Noted- y n) <br /> Storega Location Casing type <br /> Blank ft. Screen ft, <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gmvel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />