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%,oONITORING WELL INSTALLATION RBPCwO <br /> Date: a 3h ! CONSTRUCTION rr <br /> Premise Address: N _ Total Depth D <br /> Screen Length (from) 4 5 (to) (� <br /> Well No.: 3 Filter Pack (from) LA _(to) f, <br /> Benronite (from) (to)_ 40 <br /> Inspector. Grout (from) (to)_ 3-119Drilling rig type r A eA �� <br /> Permit No.—I `3 0()4 Auger O.D. _ I.D. <br /> Completion - Stove pip tie_�x�(circle one) <br /> Drilling Company: <br /> Driller: easing <br /> T <br /> height <br /> Consultant ��C- -- T <br /> Geologist c T <br /> i7l <br /> ABOVE—GRC JND CHFitM43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line S T grout <br /> Domestic well on site - (y/t) 31 • ft. <br /> It yes, location and distance - <br /> a� A <br /> — a <br /> SAMPLING — <br /> sacicn : <br /> Holding Te perature '" ,,,� <br /> M;: -"� gs Pack <br /> Method_ <br /> Screening Method P — <br /> Tracking Sheet -v/ n ) <br /> f <br /> SPOILS <br /> Storage Method .5�5 c,�k 1 MATERIALS EVEI.OPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location 6 ' r J __ Casing type C <br /> Blank 4S ft. Screen <br /> Slot size o D y _ <br /> GROUTING Bags cement <br /> ! Buckets bentonite 1 <br /> Depth to water Sags sand/gravel 14 <br /> Mix Ratios 7 p 5- Filter Pack type/size 4:�- 3 <br /> Installation Method Surge Block: - (y/V) <br /> Quantity Installed -9a- 100� Discussed with geologist: - a/ n) <br /> Type of method <br /> EH 29 29 <br />