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MONITORING WELL INSTALLATION REI-! -ii.T <br /> Date:�� �42� C� CONSTRUCTION <br /> ?remise Address: C Vou W �It7�( 1 1�, L c�. �S Total Depth 0' <br /> 7�r <br /> Screen Length (from) 4 (to) <br /> Well No.: <br /> Filter Pack (from) (to) <br /> i Bentonite (from) (to) <br /> inspector. �° �- Grout (from) (to) <br /> Drilling rig type 4"-4' RI 71WV <br /> Permit No. ���I( �1 Auger O.D. I. s <br /> pp Completion - Stove pipe/cnristie box (circle ane) <br /> Drilling Company: r. Yu^ <br /> Driller. cas Lng <br /> height <br /> ♦ 7 T <br /> Consultan <br /> Geologist ABCY=_-GRCtJNO - <br /> cx <br /> CCkV cTSON CCO . j�.1P(=i CCNCN <br /> SPECIAL PERMIT INFO. Ground Sul'" <br /> � grout ' <br /> Distance to sewer line 1 <br /> Domestic well on site - ( y <br /> ff yes, location and distance - t <br /> SAMPLING 6 ` �J�c'f`' PrM�J1c_ :lo = g' <br /> saccn — Q <br /> Holding Tem erature _ <br /> Method <br /> Screeningree�t <br /> d — <br /> Tracking S ( Y/ ri <br /> ;� ♦ = F M <br /> fJ <br /> SPOILS N /►-��d,. C vuI <br /> Storage Method MATERIALS/DEVELOPMENC &U_ <br /> Contamination Noted - (y/ n ) /u/-4Storage Location Casing type <br /> Blank fL Screen —Er- <br /> Slot size <br /> GROUTING Bags cement <br /> p Buckets bentonit - <br /> Depth to water j Bags sand/grav <br /> Mix Ratios -'� c���...� Filter Pats size <br /> --� Surge Blo • - (y/ n ) <br /> Installation Method <br /> Quantity installed <br /> ? 1 Discussed ch geologist - <br /> Type of shod <br /> EH 29 29 <br />