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. MONITORING W*NSTALLATION 4WT 1 <br /> rG S 4AKP(c <br /> Date: (,�S�OS CONSTRUCTION <br /> Premise Address: Total Depth 4� 7 to gP <br /> Screen Length (from) 1:2,!j (to) I I <br /> Well No.: '�W LC 23 R Filter Pack (from) 1 3_ (to) IDS <br /> Bentonite (from) 1 o< (to) 101 <br /> Inspector: /k Grout (from III (to) 5w l <br /> ffLL Drilling rig rypg nofdjv, <br /> Permit No. Ob��y7� Auger O.D. {Q" I.D. <br /> C� A c Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: _ <br /> Driller: casing <br /> height <br /> Consultant <br /> �Geologist 7fl AA" <br /> ABOVE-GROUND <br /> rCHR*'rY-8OX <br /> COM?LETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Six° <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) of n. <br /> If yes, location and distance - <br /> n. <br /> N <br /> O <br /> C <br /> O <br /> 11K- <br /> SAMPLING slotted <br /> tacdon = — <br /> Holding Temperature NLA = gra„d Pack <br /> Method <br /> Screening Method — <br /> Tracking Sheet - (y/n) <br /> 13y_n. = n. <br /> SPOILS S �C <br /> ✓NS MATERIALS/DEVELOPME T <br /> Storage Method <br /> Contamination Noted - ( / n 6 <br /> Storage Location Casing type <br /> BlankIzft' <br /> Screen 7� ft• <br /> Slot size 6. Z <br /> GROUTING Bags cement 47 0} <br /> Buckets bentonite 2 S` <br /> Depth to water�Z L Bags sand/gravel <br /> Mix Ratios M C Filter Pack type/size 3 <br /> Installation Method Surge Block: - (y/(n)) <br /> Quantity Installed ckl AD '7 V (k— Discussed with geo ogist: - �/ n ) <br /> Type of method <br /> EH 29 29 <br /> �rW c1✓ 3 (2 ' o Alrtl cJeficovMFIs3t^-fek <br />