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^v� VONITORING WELL INSTALLATION REAR <br /> Date: tI' �� L CONSTI1.0CTION <br /> Premise Address: 10190 4 /OzVy ' y Total D th G ° �t'`�� ->Ck �b <br /> Well No.: 45 —o2 Screen Length (from) S3' (to) 67 <br /> -Filret-Pa (from) 52' (to) b <br /> / Bentoniteo <br /> (from) S ' _(to) <br /> Inspector: `¢—e` Grout 1. (from) L (to) <br /> Permit No. Drilling -g type <br /> Auger O . I.D. <br /> Drilling Company: L— <br /> Comple on - Stove pipe/christie box ( ircle one) <br /> 10, <br /> ���� <br /> Driller: 7� * '4c� tcasing <br /> height <br /> Consultant <br /> Geologist � 6L4- Lta <br /> ABOVE-G OUND <br /> r V <br /> COMP ION lSTY <br /> SPECIAL PERMIT INFO. Grourd Sul xy <br /> COMPLETION <br /> Distance to sewer line iso grout <br /> Domestic well on site - (yQ <br /> If yes, location and distance - n• <br /> �r tl <br /> J — <br /> SAMPLING o 1'"` t12 <br /> Holding Temperature Ltd v soon = Y' <br /> Method r— = gmyW 7a <br /> Screening Method <br /> Tracking Sheet - (y/ n Tq <br /> n. <br /> SPOILS <br /> Storage Method > MATERI S EVELOPMENT <br /> Contamination Not (y Z eV L <br /> Storage Location Casm$ e �� L0 <br /> Blanks 3 ft. Screen 3 h. <br /> Slot size oto <br /> GROUTING Bags cement <br /> Buckets b ntonite <br /> Depth to water S Bags sancttgravel 1 00 lb r' stip• ut� <br /> Mix Ratios 't / Filter Pa type/size Z f <br /> Installation Method ' " W Surge Block: - (y, <br /> Quantity Installed Discussed with geo oogist: - (y 10 <br /> EH 29 29 'a, Type of method <br />