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f <br /> �v <br /> 1dONTTORING WELL INSTAL 110N REF., t1 <br /> Dare: M 0.r `� Z b U 2 CONSTRUCTION <br /> �( Total Depth I ��')" 1 ` J Z�C <br /> ?remise Address: y r <br /> / Screen Length (from) (to) <br /> Well No.: ( 1 F1ter Pack (from) (to) <br /> Bentonite (from) (to) <br /> ljGrout (570m) (to) <br /> Inspector: Drilling rig type <br /> C I Auger O.D. I.D. <br /> ?ermit No. <br /> n �74 w (�W Completion • Stove pipe/caristie box (circle one <br /> Drilling Company: <br /> Driller. ""1+�"' $ v [/x� � M�7F he <br /> Consultant_ � r --- <br /> Geologist O DsLY <br /> D,� � <br /> ��YEZ;,�pUNO <br /> — O C:C Nq, TSN cr�ssr.-acx <br /> cOMP=-,ICN <br /> � Ground su�f ata <br /> S?ECIAL PERMIT INTO. (� <br /> Distance to sewer line II <br /> Domestic well on site ( y/ n } �t'� d + 7- <br /> if ves, location and distance t' <br /> tlOfSaC `a <br /> SAMPLING aaccn <br /> —_' 7XV11 rack <br /> r?olding Temperature <br /> Method =_ <br /> Screening Method = I <br /> Tracking Sheet ( y/ n ) <br /> SPOILS <br /> MATE RIALS/D E V EL O P'.V1E NT <br /> Storage -Method <br /> Contamination Noted - (y/ n ) ming type <br /> Storage Location Blank ft• Screen <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravei <br /> Depth to water -ilter Pack typesize <br /> Mix Ratios Surge Block- ( y/ n ) <br /> Installation -Method Discussed with geologist- - C y <br /> Quantity Installed ype of method <br /> EH 2929 <br />