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MONITORING WELL INSTALLATION R g--KT <br /> Z� LOD2 NSTRUCTiON Co O <br /> Date: J � r <br /> 23 S 3 r)s4� Total Depth <br /> Premise Address:_ Seen Length (from) (ta) <br /> Filter hack (from) (to).. <br /> Well No.: Benronite (from) (t(3) <br /> Grout (from) Cte) <br /> Inspector: Doming rig type C Nt � <br /> Auger O.D. S I.D. <br /> Permit No. Completion - Stove pipe/christie box (drde one) <br /> Drilling Compan_y _ <br />'k <br /> casing <br /> Driller. height <br /> —We <br /> Consultant } <br /> r77 <br /> Geologist F „ ABCYcvROUND <br /> C_—A4P9_i,Cts! <br /> Ci•o�snd Stxf�u <br /> SPECIAL PERMIT INFO. , <br /> gra..t <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n } I <br /> If yes, location and distance - 't' <br /> — <br /> a • <br /> tEoctgd a <br /> SAMPLING ,- <br /> aoc:on <br /> Holding Temperature P <br /> ad <br /> Method — <br /> Screening Method <br /> Tracking Sheet • C y/ n) — <br /> SPOILS <br /> Storage Method MADQTLOPNENT <br /> TERIAIS/ f f <br /> Contamination Noted - (y/ n) Casing type V <br /> Storage Location Blank ft. Seen <br /> Slot size <br /> — Bags cem <br /> GR�� ent <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pacts type/size <br /> Mix Ratios Surge Block: - C y/ n } <br /> Installation Merhod Discussed with geologist - C Y/ a} <br /> Quantity Installed Type of merhod <br /> EH 29 29 <br /> VV <br />