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MONITORING WELL ][NST TION REPORT <br /> Date: b CONSTRUCTION <br /> Premise Address: t <br /> Total Depth M Ik) g <br /> Screen Length (from) (to) <br /> Well No.: _ Y, R { Filter Pack (from) - �L�(to)�� <br /> Bentonite (from) (to) ' <br /> Inspector: UA Grout (from)_. •p - — — <br /> {to) <br /> Drilling rig type <br /> Permit No. 2 z Auger O.D. I.D. <br /> -�- <br /> Completion - Stove pipe/christie box (circle <br /> Drilling Company: one) <br /> Driller. AO31 <br /> � casing <br /> height <br /> Consultant <br /> Geologist �, ^ T <br /> AVE-GaCUNQ T <br /> CO W LZrCN C4-4R*STY_a0X <br /> SPECIAL PERMIT INFO. CCMPL_nCN <br /> Ground Sulacs <br /> Distance to server line grout <br /> Domestic well on site y/ n ) <br /> If yes, location an istance - ��fl. <br /> 7-jK_tr. �'• <br /> sloroi _ c <br /> Holding Temperature ti I cicn <br /> M <br /> creening IMethod „- _ j _ — VIYWF� <br /> Tracking Sheet n) = ' HE <br /> 41 <br /> Storage ?Method <br /> MATERIALS EVEE.OPMENT,` <br /> Contamination Noted - ( . . <br /> Storage Location <br /> asing type iP V <br /> Iank ft <br /> G Screen frt, <br /> GRp[m\;G Iot size .Q Z-0 - <br /> ags cement <br /> Depth to water uckets bentonite <br /> Mix Ratios ags sand/gravel -� - <br /> Installation Method ilter Pack type/size <br /> Quantity Installed urge Block: - (y/(. <br /> iscussed with geologist: • ( y/4D <br /> EH 29 29 Type of method <br /> 1 <br />