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'c <br /> l � i <br /> .iONITORING V <br /> N REPORT <br /> M <br /> Date : I l 021 � b CONSTRUCTION <br /> Premise Address : � �Ga (.&WOL SAC, Total Depth <br /> Well No. : <br /> �. . I .G 3 t / Screen Length (from) (to) <br /> IN 7 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: ld (G Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> DrillinCompany: Completion - Stove pipe/christie bTaox (circle one) <br /> g 6 �' <br /> Driller:_ T l <br /> casing <br /> �I height <br /> Consultantl <br /> Geologist T <br /> ABOVE-GROUND <br /> COMPLETION CHMM18OX <br />� SPECIAL PERMIT INFO. GroundSurlxe COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) ft <br /> If yes, location and distance - <br /> ft. <br /> n. <br /> SAMPLING } — o <br /> c <br /> slotted = � <br /> radon x _ <br /> Holding Tem <br /> $er Cure C = <br /> Method LV43: _ _ 7"'94 Pack <br /> Screening Method =_ <br /> Tracking Sheet - y / n ) _ <br /> Y_ <br /> tt. = n, <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 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 />