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MONITORING WELL INSTALLATION RMOT <br /> sw 6 16 Sul <br /> �5 38 38 3 S ' <br /> Date: Lip ONSTR 0 <br /> p � <br /> Premise Address: 'yy�- `T or Depth GiI PX raYlZ <br /> SU)_[, <br /> U)T[ UW-Z VW_ I Sul_1b S u/17 Screen Length (from) 1 S (ta) <br /> Well No.: L Filter Pack (from) -(to) <br /> W <br /> N Bentonite (from) �-(to <br /> Inspector: W Grout (from) (to) <br /> VW_Z Drilling rig type <br /> Permit No. IAuger O.D. I.D. <br /> (� y <br /> Drilling Company: scm tj Completion - Stove pipe/christie box (circle one) <br /> J/ �i "T'( <br /> Driller: �d2� -J casing <br /> 7_) � height <br /> Consultant J r <br /> Geologist <br /> Lev 4 , <br /> VE-GROUND CHRLTN-80X <br /> COMPL�I'ION CCMPLEncN <br /> SPECIAL PERMIT INFO. j Ground Surhee <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/(n J V S r 1 <br /> If yes, location and distance - <br /> n. <br /> n. <br /> - m <br /> _ <br /> — c <br /> SAMPLINGdotted - c <br /> Ssection . _ <br /> Holding Temperagravel <br /> ture �. <br /> Method - P <br /> aCK <br /> Screening Method is <br /> Tracking Sheet - / a) <br /> SPOILS ''^^ <br /> Storage Method on SL T� /dh�^ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/CA <br /> Storage Location s r Cuing type <br /> Blank fr. Screen 2_ ft. <br /> Slot size -- <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �� Bags sand/grav-4L , <br /> Mix Ratios Filter Pack-type/size <br /> Installation Method Surge Block: -(9/ n ) <br /> Quantity Installed Discussed with geologist: -V/ n) <br /> �w19 VVJ2 Viol 5 vJ f So 1} Type of method <br /> EH 29 29 t I <br /> b 0 <br /> 1 1 -33 Sq <br /> 0 <br />