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I� <br /> MONITORING WELL INSTALLATION RE1--dT <br /> Q/ 2 �U/w _ "CONSTRUCTION <br /> Date: /y /�/q� y�{�J <br /> ?remise Address: `� Zo A% Yo M I rC 1"N7rV1 u�r' Total Depth 3 Z 12 <br /> n/� p ( nA ' Screen Length (from) -i Z (to) <br /> Well No.: I' \ — I I M IAf "Z ZM W 13INk Filter Pack (from)----Lt.. (to) tD <br /> . 11J �„I • <br /> W _6- Bentonite (from) fs I (to) g <br /> Inspector. / (N v 67 / Grout (gym) � (to) S <br /> Mw-� Drilling rig type <br /> Auger O.D. LD. <br /> Permit No. Completion . Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> f1 ( /r1�M <br /> casi.na <br /> Driller. Lrek hei.ghc <br /> � <br /> r1GE . . <br /> Consultant ( / <br /> Geologist / " � U AgCVEGRCUNO <br /> itSTYCX <br /> CCWCCNCCNF ECN <br /> SPECIAL PERMIT INFO. Gound Sulacs <br /> i <br /> praut <br /> Distance to sewer line <br /> Domestic well on site - (y/ ') ~ M <br /> BMW. Z'3 <br /> If yes, location and distance - Isl 9 —Z o tL <br /> ft. <br /> � M <br /> airier I--•� FY = <br /> •Ver. �3re — - 3 <br /> MW- — <br /> l1vJ'I � c <br /> SAMPLING a ISH ofolad = <br /> Holding Temperature = grz °w Pack <br /> Method <br /> Screening Method ( yul ( � LL <br /> Tracking Sheet - (y/ a) 2. <br /> ? Zn ♦ tt <br /> SPOILS <br /> Storage Method t MATERIALS/DE-VELOPMENT <br /> Contamination Noted - ( / n) Casing type P C <br /> Storage Location /1Yt S 'rQ Blank O IZ ft- Sanea ZCI ft. <br /> Slot size <br /> GROU ING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/graveII <br /> Mix Ratios N Filter Pack type/ <br /> Installation Merhod Surge Block: - y n ) <br /> Quantity Installed Discussed with aologisn - y/a) <br /> n _ Type of merhod <br /> EH 29 29 <br /> I \w c ,r row✓ r7�` VuC�r�n C , 11 . <br />