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MONITORING WELL INSTALLATION RFi,r.o(T <br /> Date: U <br /> CONSTRUCT70N <br /> Premise Address: �'� � �.F W � ,(r, <br /> j C Total Depth 1 <br /> WeII No.: 1 Screen Length (from)��p <br /> Filter Pack (from) (to)~-- <br /> Inspector. Bentonite (From) (to) <br /> .-�` 'I "'Grout (from) <br /> Ob (to) <br /> Permit No. 2 � 1 Drilling rig type `-"�--- <br /> Auger O.D. I.D. <br /> Drilling Company, V-Lq �� Completion - Stove pipe/Christie box (circle one) <br /> Driller: 6'i'_ <br /> ., �.., casing <br /> Consultant height <br /> 4 <br /> LC <br /> ii Geologisr-1-13 <br /> vuL r i!1 `�r�vy�G jes�- r ABOVE-GRCVNO <br /> CO fyPLEDO N CHR:S7Y-WX <br /> SPECIAL PERMIT INFO. COMPLmCN <br /> — - ••�C3ra:nd 5tsi <br /> Distance to sewer line <br /> Domestic well on site - ( �rO1'i Y/ n ) <br /> IF yes, Iocation and distance - �ft. <br /> ft. ft. <br /> N� <br /> . m <br /> r <br /> !k PLING r <br /> c <br /> slvrn.� e <br /> Holding Temperature +°c'c" <br /> Method <br /> . Vivol pacK <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> . - <br /> SPOILS <br /> Storage Method MATERIALS EvEi.OPMFNT <br /> Contarnination Noted - (y/n ) C--)Storage Location Jf �� <br /> Casing type . ,E-" <br /> Blank fr. Screen fr, <br /> GROUTING Slot size ZL� <br /> Bags cement <br /> Depth to water 2— Eu entonite <br /> Mix Ratios zgs san gravel <br /> Installation Method F ter ack type/size <br /> Quantity Installed Surge Block: - (y <br /> Discussed with geologist: - ( y/ n) <br /> EH 29 29 Type of method <br />