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{ <br /> �JNITORING WFLL INSTAL"L"ATION ItEPG -�• " <br /> Date: CONSTRUCTION <br /> � . - � . .� ..,�.� � _ . _.... Total Depth <br /> ss: <br /> Premise Addre • . <br /> - y �. Screen Length (from) (to) <br /> Well No..- <br /> C3(� Filter Pack (from). (to), ._ <br /> -. Bentonite (from) <br /> Inspector: Dh Grout (from)-_. s (to)_ e <br /> ....... Drilling rig type ' <br /> Permit No. / d�� _ - Auger O.D. - I.D. . <br /> Completion - Stove pipe/cluristie box.(circle one _ <br /> F <br /> Drilling Company: eS <br /> Driller: IN -. casing <br /> _ _ _ .' }. �.height: <br /> A - <br /> Consultant �, .w � A <br /> 77 '//. <br /> J180VE-GFiCUNE �.�y <br /> .. CHR* Y$OX <br /> COMPLET)ON , <br /> ^T caMPLr:noN � <br /> ' -`SPECIAI'PERMIT INFO. _ �' '' •' `" '� _ C3roc�b Suriacs r`* <br /> . .' grout <br /> Distance to sewer line <br /> Domestic well on site - {y/ n) <br /> If yes, location and distance - <br /> SAMPLING .. . w _ _.ti _ t.�--- slotted _ <br /> g n l C� C -.. E <br /> Holding Tem erature _ „�pack <br /> Method <br /> Screening Methods <br /> Tracking Sheet (y/ n ) <br /> SPOILS " - i ,_ .. _ `3M <br /> Storage Method f(D�'t MATERIALS/DEVELOPMENT' <br /> Contamination Noted <br /> Storage Locatior% _ ,_.r. .Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> ' Buckets bentonite <br /> Depth to'waiter SU Bags sand/gravel <br /> Mix Ratios . _ Filter.Pack'type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed w .Discussed with geologist: - (y/ n) _ . .. <br /> l9 Type of method _ <br /> EI i 29 29- �� �4ej,4— <br /> -7 7�r// � 'L�/ _ ¢ <br />