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MONITORING WELL INSTALLATION REF,, cT <br /> f�Il ZO i1 <br /> Date: 7 'V / f (/bpoz CONSTRUCTION <br /> ?remise Address: O Total Depth <br /> Screen Length (from) <br /> Well No.: "C\ Com- Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> inspector. <br /> W O Grout (from) (to) <br /> Drilling rig type " ✓ a <br /> permit No. Auger O.D. Gp <br /> pipe/christie box (circle one) <br /> Drilling Company: <br /> �r � Completion Stove <br /> Driller. J ` � casing <br /> rJ 177 <br /> �_ height <br /> C r� ��CQ ♦f I I 7 t <br /> Consultant <br /> Geologist--EL —� A3Cvr-GPCCNO <br /> CCmp=-,jCN <br /> SPECIAL ?ERMT INFO. p Ground SLeacs <br /> —46 <br /> . C �Q,M 1 r `� Trait <br /> Distance to sewer line �orL- e <br /> Domestic well on site - y n ) Nof or <br /> If yes, location and dis ce S W o� �� (� =L <br /> i 3 <br /> Q CC 73 <br /> W pa <br /> SAMPLING zP I`m hosed =� <br /> _f <br /> Holding Temperature Q ro�-�C =i1f°� <br /> :Method <br /> Screening Method (�1 <br /> racking Sheet ( y/ n ) <br /> CSS �- ♦ T tL <br /> dvM s� <br /> SPOILS f, <br /> Storage Method S l Z Q rJ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n N A d(oSW FU C 4() q <br /> Storage Location �oCasing type <br /> Blank fc Screen fr- <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water J Bags sand/gravel <br /> Aix Ratios Filter Pack typesize 4Y C <br /> Installation Method Surge Block: ( y/ n ) <br /> Quantity Installed Discussed with geologist - ( y/ a ) <br /> n Type of method <br /> EH 2929 <br /> MW --7 r U� <br /> •4 C�im l <br />