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MONITORING WELL INSTALLATION RFPs <br /> Date: CONSTRUCTION <br /> Premise Address: / Total Depth 6�'3 `0 <br /> 014 Screen Length (from) —2.991 (to)—_ <br /> Well NoJA 2� C'` L- V Filter Pack (from) (to) <br /> Bentonite (from) i (to) c-;z / 7 <br /> Inspector: ® Grout (from) <br /> (to) <br /> IjDrilling rig type 0 <br /> Permit No. Auger O.D._ I.D. <br /> p Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 1 4`b�0(�l <br /> Driller: casing <br /> height <br /> Consultants \( S <br /> Geologist L�rA - <br /> ABOVfrGROUND CHRMTY-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. G=rid Surlaes <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) ';L' . ft. <br /> If yes, location and distance - At R. <br /> I�ft. <br /> _ a <br /> SAMPLING slotted vi = c <br /> auction __ B <br /> Holding Temperature wn __ pravq P <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type r}- V <br /> Blank '1®� ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />