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MONITORINGWELL INSTAII.ATtON p-F–PORT <br /> CONS N <br /> Date: <br /> n 9 LL Q�� Total Depth (to) /F2" <br /> Premise Address: Screen Length (ftom)�—(to) <br /> Filter Pack (from)-- <br /> Well No.: A-&-I Bentonite (from)-----��) - <br /> Grout (from)— . <br /> Inspector. �� f Q Drilling rig type I.D. <br /> Auger OD*--,' <br /> Permit No. Completion- Stove pipe/clutstie box (circle one) <br /> Drilling Company <br /> –��__ casing <br /> (2 1 S he; <br /> Driller: <br /> Consultant <br /> r1 of Q ,al,gS Ava-cacuND cr�t:srr-aax <br /> Geologist '�' CO t.r°L�TiON CVAPt_—nCN <br /> Grxtrd Sutact <br /> SPECIAL PERMIT INFO. prat <br /> Distance to server line ft. <br /> Domestic well on site - (y/ n) tt <br /> If yes, location and distance - tt• <br /> A <br /> O <br /> C <br /> O <br /> SAMPLING socicn _ <br /> vpyv t Fact <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Shcet - (Y/ n) tt <br /> tt. <br /> SPOILS <br /> e•rcrxt AT S/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location Blankft. Saeen� <br /> _�— <br /> Slot size <br /> Bags cement <br /> GROUPING Buckets bentonite <br /> Bags sand/gravel z <br /> Depth to lvaterlZ° Filter Pack type�/Size <br /> Mix Ratios Surge Block: - K Y n) �� <br /> dpstalladon Method Discussed vrith eologist: - VY/ n) <br /> Quantity Installed Type of method v <br /> EH 29 29 <br />