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MONITORING WELL INST TION REpL.��"r <br /> I <br /> Date: �!is �b f 7 CONSTRUCTION <br /> Premise Address. Total Depth 2-0 f 33 <br /> 1 <br /> Screen Length (from) (to) <br /> Well No.: !tom '0 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector• Grout (from) (to) <br /> Drilling rig type <br /> Permit No. °' Auger O.D._8 type <br /> I.D. " <br /> -d I A.. 1_d. Completion- Stove pipe/christie box (circle one) <br /> t Gkf <br /> Drilling Company: All <br /> ,a 4� <br /> Driller: Zj 1 _ casing <br /> height <br /> Consultantt <br /> Geologist 6aAo,-- - <br /> -/,,, . <br /> ABOVE-GROUND CHRIS'7'14M � <br /> s. '•:• COMPLEf1ON COMPLETION <br /> SPECIAL PERMIT INFO. G=nd Surface <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - . <br /> SAMPLING <br /> :• —__ n <br /> a wc'aon <br /> Holding Temperature t' „� <br /> Method P , <br /> * 3 <br /> Screening Method - x _ I i <br /> -.f Tracking Sheet (y/n,) s 'A: — <br /> • ve�E2�f. <br /> SPOILS SRS A.C. <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 2`►f�l![� 3 3 <br /> Storage Location Casing type O.OZD . <br /> Blank ft. Screen ft. <br /> Slot size 6.07_.0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water it fess Bags sand/gravel -14 <br /> Mix Ratios Filter Pack type/ ize <br /> Installation Method Surge Block: - y n ) <br /> Quantity Installed Discussed with geologist. - l J n) <br /> __. Type of method <br /> EH 29 29 <br /> r <br />