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i <br /> MONITORING WELL INSTALLATION REI--r<T <br /> Z3oC3 J CONSTRUCTION <br /> Date: fII <br /> premise Address: dry ` CN [ `'So-y\ � Total Depth � <br /> Screen Length (from) 30 (to) <br /> Filter pack (from) Cto} <br /> Well No.: S�r�'i'a(iinn to Z <br /> Bentonite (from) ( ) <br /> Ll Grout (from) (to) <br /> Inspector. Ding rig type <br /> Auger OD. I.D• <br /> Permit No. n a Completion - St Piped. tie box (circle one) <br /> Drilling Company. S(Ct I <br /> 1 C391aQ <br /> Driller- <br /> Consultant <br /> rillerConsultant <br /> Cil <br /> Geologisc N ' A2ZVE-.;ROUND CHRIS—I y-SaX <br /> Mcr k.0 � — (�l.P!_`TfON COMPt=i rCN <br /> a' =� Ground SLrfac* <br /> SPECIAL PERMIT INFO. M $ ""k <br /> gr I out <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n�) SMP `L <br /> [f yes, location and disranc - t <br /> SAMPLING I r tb�d <br /> SO w. _ <br /> Holding Temperature _ 7wel pack <br /> Method t 4C = I <br /> Screening Method------ p <br /> Tracking Sheet - ( y/ a ) 8 3Le <br /> 4�S bsn ♦ _ _ ♦ tL <br /> o. Y 3 G .. <br /> SPOILS /` CA <br /> Storage Method tl C —/DEvEL /It <br /> Contamination Noted - (y n fI �(/ Casing�e 6 v �j <br /> i <br /> TI <br /> Storage Location `f T Bl [t Screen----= — <br /> Cptl� S�f��D p(/1J1gR1(t Z ( Slot size <br /> Bags cement <br /> ROUNG JV1 �,�/r l�r 5 S r <br /> Buckets bentonite <br /> Bags s d/gtavel <br /> Depth to water Z y Filter Phckc type/ e <br /> Mix Ratios Surge Block- - n ) <br /> Installation Method Discussed with ill - / a) <br /> Quantity Installed Typ of m shod <br /> EH 29 29 <br />