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MONITORING WELL INSTALLATION REI�7lfT <br /> Date:.- 3 7 / <br /> o, CONSTRUCTION <br /> Premise Address: l l 1 5Filter <br /> epth <br /> Well No.: [� Ak 2Length (to)---__.. <br /> (from) (to) <br /> /_ t9e (from) (to)__ <br /> InspectOr. fo.-�'I Grout (from) (to) �0 <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. 4 <br /> �7 Completion-Stowe ip pe/christie box (circle one) <br /> Drilling Company: //�}� i <br /> Driller. r <br /> casing <br /> height <br /> Consultant o <br /> 11aGeologist T <br /> COMPLETION '� <br /> COMPL.ETMN <br /> SPECIAL PERMIT INFO. ) Ground Surface MT-_ - .� <br /> Z d�kol �Z/ <br /> Distance to sewer line 4r«n� � <br /> Domestic well on site - y n ) p p r ZL )Z <br /> If yes, location and disterice - fL <br /> fL <br /> SAMPLING C) sbkkad "Ilk <br /> 0 M1, aeon <br /> Holding Temperature d; pack <br /> Method.," <br /> Screening Method NO <br /> Tracking Sheet - (y/n ) Oda( ` cJ <br /> n <br /> Spoils r �. <br /> Storage Method(L MATERIALS/DEVELOPMENT <br /> Contamination -ted /Storage L°ca�ioh ("ll't Cas type <br /> Blank ft. ft. <br /> Slot size <br /> GROUTING Bags cement <br /> I Buckets bentonite <br /> Von <br /> er d nt kr Bags san(/ <br /> Filter Pack size <br /> ethod Surge B - - (y/ n ) <br /> alled with geologist•. - (Y/ n) <br /> T ethod <br /> Nk <br /> Eli 29 29 "vj �� <br />