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MONITORING WELT.IN 17ALLATION REPORT <br /> lJi <br /> Date: <br /> I <br /> CONSTRUCTTON <br /> Premise Address: -2- <br /> T-O.'S Total <br /> -j-- Total Depth p <br /> Well No,• _ Screen Length (from) (to) <br /> • Filter pack (from) ------ <br /> Inspector. Bentonite (From) <br /> Grout (from) (to)_—--`� <br /> Permit No. �- Drilling rig We <br /> Auger O-D. 1.D. <br /> Drilling Company: 1M. Completion - Stove pipe/cluristle box (circle one) <br /> Driller. <br /> casing <br /> Consultant height <br /> 4 '4 <br /> Geologist <br /> AVE-GrR CUND <br /> SPICIAL PERMIT INFO. COWLEWN G�A;S7Y�OX <br /> Ground Sirf�cs C-Ot_mCN <br /> Distance to sewer line <br /> Domestic well on site - (y proof <br /> I:Yes, location and di ce . <br /> rr. <br /> s,�—�G n <br /> �ror� <br /> Holding Temperature [ <br /> Me <br /> Method <br /> tac�cn <br /> Screening Method _ grxvwP.U* <br /> Tracking Shcet . Y/ <br /> n r' <br /> SPOILS 1 ft. - 0 n. <br /> Storage -Method <br /> Contamination Noted - (Y/ MAU!16LS EVELOPMENT <br /> Storage Location <br /> Casing type <br /> GGBlank .5- ft. Screen <br /> R—��`'G Slot size <br /> Bags cement ti ,S <br /> Dept to water ^_,7 , Buckets bentonite <br /> Mix Ratios ., Bags sand/gmvcI <br /> lnstallat:on Method Filter Pack type/size z <br /> Quanri ti <br /> ry InstalIcd � Surge Block: - (y/ <br /> Discussed with geosy <br /> t: - ( / n <br /> EH 29 29 Type of Method <br />