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MONITORING WELL INSTALLATION ?Ja--t l /) <br /> 14 i 5 iv\ c,- JA ,r-,4 <br /> Gale 4 � I sd OvAA- <br /> � 99 p� p�2 SB 1g <br /> VvD1l �q� LC � oNST�ucrt N <br /> Date: ➢ t C 1 Q <br /> �IPSa oral De rh "� �'�✓"�� <br /> oretnise dress: ` M� i Iv creen Len (from (to) <br /> 1511, ( S i? g t: �� — I �/ lter Pack (from) (to) <br /> No.: ll / entonite (from) (to) <br /> LJ Grout (from) (to) <br /> e Inspector. z (� i tilling rig type_ / it 2-n a <br /> D / ger o.D.__—_yL–LD. <br /> #NO Permit No. (ri C mplerion - Stove pipe/cnnstie box (circle one) <br /> 3 q <br /> PSI ra <br /> Drilling Company: saKd <br /> `I'7 cas ia4 <br /> k Tiller. Zj �i _ 1 height <br /> onsultant � �C <br /> t <br /> Geologist _� fQ ��(SABCVEvFCUND �u;v.gcx <br /> ` <br /> ssppp`�jo CC'P 1 - -' , SD 5 M CCf L.=- 10N CCMP��TiCN <br /> (D�I0.SPEZ IAL P RNIIT Cycund SLrf c �---- <br /> 1Z i r <br /> 10 1 0 ' 12� , 9rcut <br /> Distance o sewed' t <br /> Domestic well on si y n <br /> If yes, location and distance - L fL <br /> • <br /> 5Yo1xf SatviP I{&6753. <br /> Z ,Jarc:an <br /> Cal kr I S-1 5,4WgIk <br /> Holding p e - C <br /> ��ayye Me[hod . <br /> ScreeningMethod ice' <br /> Tracking Sheet • ( y/ n) ,bal R tt <br /> h�1e � <br /> 1 S SPOILS // <br /> lep RIALS/D <br /> a� Storage VIetho¢ <br /> Ol n Contaminon Noted - C y/ n ) _ ing type <br /> Storage ocauon bo fr- Screen fc <br /> C rW�y Slot size� Bags cement <br /> GROUTING 0 Buckets bentonite <br /> Koa <br /> 1St � � 00 ags sand/gravel <br /> Depth to water <br /> Ater Pack typesize <br /> Mix Ratios i ro e Block - C y/ n ) <br /> Installation Method w Z iscussed with geologist: - C y/ n) <br /> Quantity Installed 73; a of method_ <br /> EH 29 29 <br /> yeSerday�Cr <br /> 6 � dat/ <br />