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)NITORING WELL INSTALLATION RFA <br /> Date: ✓ pZ CONSTRUCTION <br /> Premise Address: -� V�? Total Depth M <br /> Screen Length (from) 38 (to) 1 <br /> Well No.: 4 Filter Pack (from) 38 (to) 17 <br /> Bentonite (from) 11 (to) IS <br /> Inspector: Grout (from) 15 (to) O <br /> Drilling rig type_ Ow 5 <br /> Permit No. 9Z Auger O.D. I0l 2. I.D. T j <br /> Completion - Stove pipe/chrisrie box (circle one) <br /> Drilling Company-c% 1,�►l <br /> kV=--..A <br /> sing <br /> Driller: ��L ight , <br /> /e, <br /> Consultant T <br /> c[ \ T <br /> Geologist 4 Fj <br /> CONPL i ICN CHRISTY-BOX <br /> COMPLY ICN <br /> Ground SLeacs <br /> SPECIAL PERMT INFO. <br /> groat <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n) <br /> If yes, location and distance - I '7 n- <br /> - a <br /> — o <br /> sioitad ;1 _ d <br /> SAMPLING sacdongra <br /> _ <br /> Holding Temper Lure i 441r _ '�'' <br /> Method6-�-� -A = <br /> Screening Method <br /> Tracking Sheet - ( y/(g)) 3 <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y it <br /> Storage Location dyt WLa Casing type <br /> Blank 18 ft. Screen ZJL) ft. <br /> Slot size - tJ I <br /> GROUTING Bags cement <br /> Buckets bentonite 64ps <br /> Depth to water Zg Bags sand/gravel 7 t <br /> Mix Ratios it(LaFilter Pack type/size l Z- L` <br /> Installation Method Surge Block: - 6/ n) <br /> Quantity Installed S-'5 Discussed with geologist: - G/ n ) <br /> Ty <br /> pe of method 3Q --- <br />