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�IMONITOI <br /> RING WELL INSTALLATION LIT <br /> s M <br /> Date• _ _— '' CONSTRUCTION <br /> Premise Address: �// '� �ys T o tal Depth [ <br /> s Screen Length (from) z (to) Z <br /> Well No.: �J� �� Filter Pack (from) 2 (to) A- <br /> Bentonite (from) ` z- (to) 3 Y1 <br /> Inspector: Grout (from) V2 (to) <br /> Drilling rig type r <br /> Permit No. Auger O.D. I.D. <br /> Lq$L Completions- Stove pipe/cluistie box (circle one) <br /> Drilling Company:_ -- <br /> Driller: �. casing. <br /> height <br /> Consultant W <br /> Geologist 676i <br /> ABOVE-GROUND GHFiJ.STY�OX ' <br /> t,- COMPLETIONCOMPLEMN <br /> SPECIAL PERMIT INFO. Ground Surfws <br /> Distance to sewer linegrout/ r <br /> Domestic well on site { / -5 <br /> If yes, Iocation and di c ft. <br /> I <br /> - <br /> SAMPLING <br /> r <br /> LYC1Cf1 !,� � i <br /> Holding Temperature <br /> Method _ -* = Gn W Pads <br /> -� <br /> Screening Method c? VW �. <br /> Tracking Sheet (y/ n ) = / <br /> Jt. <br /> SPOILS <br /> Storage Method V � ` i'� �r S MATERIALS/DEVELOPMENT <br /> Contamination Noted - {yn <br /> Storage Location '" s,�e Casing type U C <br /> Blank ft. Screen <br /> Slot size - <br /> GROUTING J Bags cement <br /> Buckets bentonite <br /> Depth to water- ref Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/n } <br /> Type of method <br /> EH 29 29 _ <br /> r <br />