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4�,p� MONITORING WELL INSTALLATION REIPJWi <br /> y �4z,"Qc_�_ <br /> Date: (\AW CONSTRUCTION <br /> Premise Address: oral Depth J � <br /> Screen Length (from) Z (m)__( <br /> Well No.: ,Z Filter Pack (from) (to) <br /> t entonite (from) (to) <br /> Sul/Inspector: N Grout (from) 11, 6 (to) Sul/ <br /> g rig type 's J <br /> Permit No. Auger O.D. •'Q °. _ I.D. 7, <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company. �� r <br /> Driller s' casing <br /> ghr- <br /> Consultant <br /> Geologist <br /> ABCVE-GROUND CHRL.S'TY-box <br /> OC&PLEMON CN <br /> SPECIAL PERMIT INFO- Ground surface '_ <br /> M ' <br /> Distance to sewer line 1 tf , s <br /> Domestic well on site - (y/ n } _ � —`l �_`t. <br /> If yes, location and distance - '� 1 1 `1=K. <br /> L 9s L <br /> fL <br /> SAMPLING stottad a _ a <br /> C a*C'cn _ s <br /> l� <br /> Holding Temperature = P <br /> Method <br /> Screening Method 7�61 <br /> Tracking Sheet - C y/ n) 25 . = JL <br /> fL �.�. <br /> SPOILS � 5 0C+Ci1ct0MATERIALS EVELO . <br /> Storage Methodr� e <br /> Contamination Noted - (y/ n) ` Casing type <br /> ' <br /> Storage Location Blank ft. Screen ft• <br /> C� JJZ ry Slot size <br /> Bags <br /> �— <br /> GROUTING S cement <br /> �\ Buckets bentonite <br /> NJ c Bags sand/gravel <br /> Depth to water n Filter Pack type/ e D z0 <br /> Mix Ratios L Surge Block: C y n) <br /> Installation Method Discussed eologist_ - y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 Y <br /> _ ��� C'01 �� C� <br />