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• A <br /> iVIONITORING WELL INSTALLATION REPOT,f <br />� a���'�r y# ,.g e ~i-�a."'� .T=r�� �i�p ,� A� w'"' +�, 1 i J•f SIlL r �� � <br /> Date: CONSTRUCTIONIN <br /> IE <br /> Premise Address: Total Depth <br /> �. � ._,, <br /> i Screen Length (from) 8 {to) <br /> Well No: ' �W'Jr� _ * `' ' _" Filler Pack ' (from) 'Y" s (to) t03 <br /> Bentonite j. ` `(from), �'S�. (to) (O 1 <br /> ` Inspector: '-" ' Grout (from) fol (to) 5 <br /> ,. .Dulling rig type <br />! Permit No.- ' �- 7� 3 Auger O.D. I.D. <br /> r r Completiocl <br /> n - Stove pipe/christie box (cire one) <br /> Drilling Company: � dtGtit�t % ' qlpIy .. . - <br /> 101 <br /> Driller: <br /> `h �-. `�` e casing <br /> r <br /> ` height <br /> Consultant <br /> GeologistL/ As6vr=-r.RCXJNO <br /> COMPLEClON CtiR�M43OX <br /> comPLEFiOiV s <br /> SPECIAL PERMIT INFO. 1 Ground Sulaaa <br /> Distance to 'sewer line " if <br /> grout <br /> T Domestic well on site - n <br /> (Y <br /> � �. <br /> If yes, location and distance - <br /> P tL <br /> b <br /> SAMPLING <br /> sac'ion — <br /> Holdtng'TernpeA lire gnvwparc <br /> Method �, . f "•` <br /> Screening Method " <br /> Tracking Sheet -' .n) — <br /> �} 5. <br /> } <br /> oilX4 <br /> ` <br /> SPOILT C <br /> S i.#�,' .- ,� . _.,p. s..p,,,{.5�� ? ,j y�:'qr + +,�. �,...•- r '"}# - } <br /> Storage Method 55901MATERIALS/DEVELOPMENT-11t <br /> f <br /> Contamination. (y/.n ) � , �_ "4 ` ,' ,` ' ' ?'4.. `x �( 'n ./ ev Jo <br /> Storage Location--- a*. , r,.Casing type. <br /> .� Blank ' 'ft.- Screen <br /> Slot size :! , <br /> m� , <br /> GROUTING " . , ; . , w K •:_; Bags cement. <br /> w. <br /> Buckets bentonite <br /> s <br /> i «: q• * . `} <br /> 5 S iy y <br /> to water� � Ba s sante avel - <br /> De <br /> Depth - g gr <br /> - p � <br /> N Filter Pa type/size- <br /> Mix Ratios ,. 3 �;.:;.*.�•,�;.-� ck tyr / <br /> Installation Method r Surge Block: <br /> Quantitylnstalled'l"" Discussed°with gea gist:" n ) /On <br /> method .t0W g <br /> EH 29 29 <br />