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. MONITORING WEJ L iNSTALLATIOIPORT <br /> Date: 0t+ <br /> ` 1----- CON_ STRUC77pN <br /> Premise Address:_,c (�,7rt aY (2y-c' <br /> WGI S <br /> \'1 t Total Depth I 05 t <br /> Well No.: M V) _-J- Screen Length (from) <br /> p <br /> Filter Pack (from) qs{ <br /> Inspector-. Bentonite (from) (ro)- r-- <br /> Grout (from)�t9-_(to) S <br /> Permit No. Drilling rig type <br /> Auger O.D. <br /> Drilling Company: (A��r p� n Completion - Stove pi diristie box (c cle one) <br /> Driller. \�a� <br /> casing <br /> Consultant. height <br /> Geologist <br /> A°CVE-GRCCND ` <br /> SPECIAL PERMIT INFO. �t pL-`TbN CtAS7y 3pX <br /> CCMPL_R1CN <br /> Cxund SuixY <br /> Distance to sewer line <br /> Domestic well on site y/ rl Cr«t <br /> if yes,location an istance - <br /> f t. <br /> 00 h. ft. <br /> - — a <br /> SAMPL]NG = <br /> — c <br /> Monad = c <br /> Holding Temperature sac5cn = <br /> Method ( — <br /> Screen n, Method = LT+vd yadt <br /> Tracking Sheet - (y/ n ) i <br /> SPOILS I O S ft. <br /> Storage method O l 0 <br /> Contamination Noted - (y/n ) M—ATERJ4, S/DEV- OPMENT <br /> Storage Location �In f7 tiA S� r7 <br /> Casing type <br /> Blank_ <br /> GI orJ fr. Screen�_fr <br /> R— 0 Slot size p Zr-� <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios_ Bags sand/gravel <br /> Inst Nation Method Filter Pack type/size <br /> Quantity Installed Surge Block: - tt ) <br /> Discussed with geologist: . ( y� <br /> FH 29 29 Type of method <br />