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-- vIONITORING WELL. INSTALLATION REI•......r <br /> Date:. 2 ' Q, ) CONSTRUCTION <br /> Premise Address: `t �� N• SCi;1 6cgQ w�2 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: MW Sf • Filter Pack (from) a (to) <br /> p Bentonite (from.) 4 (to) <br /> Inspector. 1�� Grout (from) 417 (to)� <br /> �}---,� Drilling rig type E5 <br /> Permit No. �' �� � ��- I +rM Auger O.D. R" LD, <br /> ^ Completion - Stove pipe/ sate box circle one) <br /> C-"i Y <br /> Drilling Company._ yk-D <br /> lam Nrh5 <br /> Driller: v't-v� cas,ng <br /> he-ght <br /> Consultant t 7 <br /> Geologist l,irt� Y ABOVE-GROUND CIMM-aoX <br /> COlri€L TION COMPL-EnON <br /> SPECIAL PERMIT INFO. Omnd Sudacs <br /> Distance to sever line 2e- great <br /> Domestic well on site - (y n 4C7 <br /> If yes, location and distance - if. <br /> A <br /> w O <br /> SAMPLING <br /> `rD tYCSCri <br /> Holding Temperatur -1lL <br /> Method W05 tGe b t ca e ire _ <br /> Screening Method }` <br /> Tracking Sheet y n } <br /> SPOILS n <br /> ,, � �YldtrtiNl►�!?t� <br /> Storage Method l(,V, 4rVJ 5;-1v-vV e btVl # 5✓7- MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ N( ��� <br /> Storage Location OCC,t 1 e Casing type <br /> Blank ft. Screen 15 ft. <br /> Slot size . DID <br /> GROUTING Bags cement $ <br /> �_�" Buckets bcntonite 1 -Act &vj <br /> Depth to water Bags tiQC�'��'� Filter Pa type/size <br /> �t�� <br /> Mix Ratios 6 to <br /> Installation Metho �C cl r fP Surge Block: - U/ tt ) <br /> Quantity lnstallcd 5 Z 4.k-y Discussed with geologist: y n ) <br /> Type of method 2" 57irr o <br /> EH 29 29 <br />