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MONITORING WELL INSTALLATION RFPOIko <br /> Date: f CONSTRUCTION <br /> Premise Address: Ila , Total Depth L�� / <br /> a/ I Screen Length (from) Wa (to) LD <br /> Well No.: ' -� Filter Pack (from) %2 (to)- <br /> Benronite (from) 9 (to) /6 <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Z o 6 S Auger O.D. I.D. <br /> �� (f Completion - Stove pipe [sue box ircle one) <br /> Drilling Company:-,��,v r��`_ <br /> Driller: ////P casing <br /> F, � height <br /> Consultant /� /Lif//� ± 6 , <br /> Geologist /i A(D45; - r <br /> ABCVE-GACUND CNAISiY30X <br /> COMPI ETION COMP=CN <br /> SPECIAL PERMIT INFO. G=nd Socha <br /> Distance to sewer linrt <br /> e ora <br /> Domestic well on site - y/ f6 <br /> If yes, location and distanc F ft, <br /> 20 <br /> = o <br /> SAMPLING tit-Z h slorad = d <br /> ;0P accycn <br /> Holding Temperature_ _ �,Yd F <br /> ack <br /> Method <br /> Screening Method r <br /> Tracking Sheet - ( y/ n ) ; <br /> SPOILS <br /> Storage Method -SA 'h/ 1A -(e �_g• MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ <br /> Storage Location s� I-Ve/y� Casing type ; 40 <br /> Blank ft. Screen 20 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> r Buckets bentonite <br /> Depth to water_ 2 4 _ Bags sand/gravel <br /> Mix Ratios . Filter Pack type/size <br /> Installation Method ( Surge Block: - ( y/I <br /> Quantity Installed �.e/ Discussed with geo ogist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br /> /Elul <br />