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( i <br /> J <br /> jOMONITORING WELL INSTALLATION REPO lr <br /> ii; NI <br /> Date: a� CONSTRUCTION <br /> Premise Address: q 3'� -c- t� Total Depth <br /> (fro <br /> Screen Length m) (to) <br /> '+ <br /> Well No.: w Z �"�'^'-3 Filter:PackI (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: _ Grout �!. r (from) <br /> (to) <br /> Drilling rig hype <br /> Hermit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> j Drilling Company: <br /> Driller• . ��` <br /> casing <br /> jl height <br /> Consultant <br /> Geologist <br /> AZi 0 E-GACUND <br /> k CC�PI.ET16N CHMM43CX <br /> r SPECIAL PERMIT INFO. I�. C3=nd Swfacs COMPLE°TICN <br /> j! pj <br /> Distance to sewer lute 9;0u <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - I <br /> it. " <br /> SAMPLING ��' d t✓ � = o <br /> - 81orad <br /> on <br /> Holding Temperature <br /> Method z! _ gnvW Pack 1 <br /> Screenin;Method .._ <br /> it Tracking Sheet - (y/ n ) — - <br /> SPOILS <br /> Storage Method MATERIALS DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank:° fL Screen ft. <br /> Slot size <br /> GROUPING Bags cement. <br /> (/ Buckets bentonite <br /> Depth, to water �T Bags sand/gravel <br /> Mix Rados Filter-Pack rype/size <br /> Installation Method Surge;Vock:l- (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) } <br /> Type of method <br /> EH 24 29 <br /> ' J <br />