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r k0 " 0 <br /> MONITORING WELL INSTALLATION REI--rcr <br /> i <br /> L <br /> CONSTRUCTION <br /> Date: - <br /> l�f t"• k'q � -�/� 6`jl� Total Depth <br /> ?remise Address: Seen Length (from) (to) <br /> Well No.: �uJ ` y Filter Pack (from) (to) <br /> Benronire (from) (to) <br /> Grout (from) Cto) <br /> inspector: . Drilling rig type <br /> Auger O.D. M. <br /> Permit No- Completion -Stove pipe/christie box (cirde one) <br /> Drilling Company: � <br /> ' casing <br /> Driller. heighr t,177 V <br /> 7 <br /> Consultant�� <br /> Gep1ogist� <br /> // ASC+l;-v^AQLiND p�GST"-30X <br /> CC&F ETION C p�_iCN <br /> C-+caasrxf 5isiaca <br /> SPECIAL PERMIT INFO. <br /> �� <br /> Distance to sewer line r <br /> Domestic well on site - ( y/ n } �• <br /> if yes, location and distance - �- <br /> a <br /> C <br /> SAMPLING :tcr� <br /> M• <br /> p C/ — swi e"-2ciC <br /> Holding Tempe tvre,_ L� -- <br /> Method <br /> Screening Method — <br /> Tracking Sheet - / n 1' _ <br /> SPOILS 0, ` <br /> Storage Method Sv�2 � MATERTALS/DEVELOPMENT <br /> Contamination Noted - yjj n) <br /> Storage location �"- 1� Casing ripe <br /> Blank fc Screen____.ft_ <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Sags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block, - C y/ n ) <br /> Quandry Installed Discussed with geologist: - C y/ n) <br /> Type of merhod <br /> EH 29 29 <br />