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' ONTTORING WELL INSTALLATION RFPo -- i <br /> Date: L-i 1 -Z ° _cL __ CONSTRUCTION <br /> a <br /> Premise Address: i 3 O 5 Jo 0A LA-- Total Depth � �S <br /> Screen Length (from) ' (to) <br /> Well No.:_ Wil,E W- j Fitter Pa (from) (to) fL �7-1 _ <br /> Bentonite - (from) 6' (to) _ <br /> Inspector: Grout (from) (to) b <br /> Drilling rig type. <br /> Permit No. Auger O.D. to " I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company. 1 ra <br /> Driller: c- casing <br /> height <br /> Consultant L . <br /> y <br /> Geologist Vj n <br /> � A - <br /> ABOVE-GROUND CHR Sry-aoX <br /> COMPLET;ON COMPLETION <br /> SPECIAL PERMIT INFO. l w Ground Suwwrl <br /> Distance to sewer line 2f Out <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ry <br /> •.S m <br /> ' O <br /> SAMPLING , slatted : <br /> soclon N4 — r <br /> Holding Temperature ei <br /> Method G gravel Pack <br /> Screening Method Vi c) <br /> Tracking Sheet - tiJ n ) _ <br /> SPOILS _ <br /> Storage Method cry +hc- MATERIALS/DEVELOPMENT . <br /> Contamination Noted - (y/ n ) + i nn � 1 <br /> Storage Location ren 5�, Casing type Li / / .Y Lf tJ <br /> Blank_ 40 Screen � L5-- ft. <br /> Slot size ollo <br /> GROUTING Bags cement <br /> - Buckets bentonite. - <br /> Depth to water Bags san gravel-, N t3 <br /> Mix Ratios I Filter Pa k yWe size_ <br /> Installation Method Surge Block: - (y/rr <br /> Quantity Installed - Discussed with geologist: - C/ n ) <br /> Type of method <br /> EH.29 29 . <br /> .s <br />