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MONITORING WELL INSTALLATFON REF-.,�Tr <br /> CONSTRUCTION <br /> Date: 1, <br /> 4 rt,lr'I� Total Depth <br /> ?remise Address: Screen Length (from) (t°) <br /> Filter Pack (from) _(to) <br /> Well No.: 14 I� <br /> Bentonite (from) (to) <br /> y� Grout (°.tom) (to) <br /> .nspector: Drilling rig type <br /> Auger O.D. I.D. <br /> ?errnit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company <br /> T C33 L:1Cy <br /> Driller. I♦� , — *te:ghL <br /> Consultant U or <br /> Geologist r p V <br /> A$CVEwAOUND <br /> C~tvSr!="'iON Cep(=i,CN <br /> Gralyd Sirfrs <br /> SPECIAL PERMIT INFO. , <br /> PQrcc.2 <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) <br /> If ves, location and distance - <br /> C (CAW, <br /> s =1 <br /> Z <br /> SANtI'LING •• clactae <br /> J <br /> Holding Temperature =i <br /> Method <br /> Screening <br /> Method <br /> Tracking Sheet . ( Y/ n ) - ' <br /> SPOILS <br /> MATTE RI /DEVE'OPNENT <br /> Storage Method-- <br /> Contamination <br /> ethod _Contamination Noted - (y/ n ) Casing 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 Filter Pack typesize <br /> Mix RariosSurge Block. C Y/ n ) <br /> Installation Method_ Discussed with geologist- - C y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br /> W'A <br />