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NITORING WELL INSTALLATION 1. .ORT <br /> 1 <br /> tONS�ON <br /> Date: p �S <br /> 1SC117 �keoh DCpc� Lad Total Depth <br /> Premise Address: Screen Len gth {from) Cto)1_ k <br /> Gy <br /> Filter Pack Cfrom) Cto) <br /> wen No.: 6 1S <br /> Bentonite' (from) D '(to) <br /> ' <br /> 3p*MA✓1 Grout (from) <br /> GTE S7 <br /> Inspector: 4935-0 <br /> Drilling rig typ <br /> 5� <br /> 60 6 S 3 5-O Auger O.D. I.D. w <br /> Permit No. p // Completion ove i Christie box (circle one) <br /> Drilling Company: WOO KwoLt!' <br /> / �•� casing <br /> Driller: (f' A.)& height <br /> Consultant K Q' <br /> f 1 GL Por. . <br /> Geologist /,gOVE-GRIXINDF51y$pX 1. <br /> CGNPLETION -COMPLETION <br /> Cico'�cd Surira o ' <br /> SPECIAL PERMIT INFO. grout � <br /> Distance to sewer line 1 ft. i <br /> ft. <br /> If yes, location and distance- ft S <br /> i <br /> f — <br /> 0 <br /> SAMPLING <br /> pnvsi parks <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) f y ft• _ ! �� t. <br /> SPOILS <br /> • MA•18RIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/n) Casing type Z rr SfHy6 P <br /> Storage Location Blank____ ft Screen%o ft• <br /> Slot size o O <br /> GROVITNG Bags cement ?. <br /> Buckets bentonite O.E <br /> Bags gravel 2 r2 <br /> Depth to water-----. Filter Packtype/siz CD»n Nf <br /> Mix Ratios _ .ySurge D1ock:_(.9-a) <br /> Installation Method _ ,- Discussed with geologist: - (y/ n) <br /> Quantify Installed Type of method <br /> EH 29 29 ; <br /> r <br />