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ONITORING W AI-INSTAU ATIO f 1pn &' <br /> Date: CONSTRCICT[ON <br /> Premise Addfi's <br /> Total Depth <br /> Screen Length (from) <br /> Well No,.*- {. Filter Pack<. (from) (to)_ <br /> _ , <br /> Bentonite (from) <br /> # • r <br /> Inspector. v� ; «, � <br /> -----�-- <br /> a t <br /> I Grout b . k (from} , _ - (toy <br /> 4 I Drilling rig type <br /> PermitNora t `. <br /> 4 Auger Q.D. ., I.D. <br /> Completion-Stove pipe/christie box '(circle one) <br /> Drilling Company-, <br /> -,r <br /> �1 <br /> Driller: d casin <br /> height` <br /> • pyx <br /> Consultant <br /> Geologist � �i y BOYt <br /> �r �y F t <br /> ` 47r�`M.Gi tl4./F4 ... ... ...aya;:.. /V�iY/"��vYj3jtND Np{�}}���i++��L}75YI1/;!. r. <br /> SPECIAL RERMIT INFQ:; act <br /> . <br /> f i <br /> !%�SLR •`. i <br /> Distance to sewer line t 77 -stout I <br /> Domestic well on site =(y j n h ^� It. <br /> It yes, location and distance_•- <br /> tL <br /> _ r <br /> a <br /> SAMPLING, ., . <br /> Holding TemperaturePack <br /> r t <br /> Method <br /> �. <br /> Screening Method <br /> Tracking Sheet <br /> •mow • t <br /> sP©IIS . • >#;,. ° <br /> ,t <br /> St rage lVlethad, _ MATERIAAI.SSIbEVEI.CtPEN'I' <br /> ContaminationNoted = (y t rt <br /> Storage Location. _ Casing type <br /> Blank ft. Screen ft <br /> Slot size . <br /> ROUTING .;, a I N j Bags cement <br /> ,Buckets bentonite" . , <br /> Depth to water,T . Bags sand/gravel- <br /> Mix.Ratios .:: , , Filter Pack'typelsize <br /> . Installation Method Surge Black: (y/n } 4 <br /> Quantity Installed <br /> � Discussed with geologist: - (y!n) <br /> Type of method <br /> EH 29 29t <br />