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MONITORING WELL INSTALLATION R � <br /> Date: / /9V CONSTRUCTION a <br /> Premise Address: ��r3 nr 7 I Total Depth I <br /> C13- Screen Length (from) 99 (to) 67 <br /> Well No.: I_ t Filter Pack (from) 99 (to) 6 <br /> Bentonite (from) g�4- (to) 6. <br /> Inspector: Grout (from) S- (to) <br /> Drilling rig type 1-t 0 dek 4�ff <br /> Permit No. Auger O.D. I-D. - 2S <br /> Completion - Stove pipe/christie bog (circle one) <br /> Drilling Company: nervy <br /> Driller:_ a/[ k S S , �d n 4 / S�� casing <br /> height <br /> Consultant <br /> Geologist •- T <br /> Ai;VE-GRIX]ND CHRiSTY-30X <br /> CO&PCN CCMFi .=TICN <br /> SPECIAL PERMIT INFO. Around S <br /> Distance to sewer line krait <br /> Domestic well on sit�y( '/ n ) <br /> If yes, Iocation and ce - n- <br /> tt. <br /> C <br /> - Q <br /> SAMPLING :io6d C <br /> C� aac�ian <br /> Holding Temperature" _ gn;-W pack <br /> Method > = <br /> Screening Method ` — <br /> Tracking Sheet - (y/ n ) :' <br /> tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) , /0 <br /> Storage Location Casintype V <br /> Blank- ft., g Screen Ca fL <br /> Slot size �J <br /> GROUTING Bags cement 17 <br /> `Z Buckets bentonite <br /> Depth to water Bags sand/grave! <br /> Mix Ratios Filter Pack type/size Z5 <br /> Installation Method Surge Block: - 0 n ) <br /> Quantity Installed Discussed wi eologist:/ �)' n) <br /> T of metho �/ <br /> EH 29 29 <br />