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10MONITORING WELL INSTALLATION RA <br /> Date: V I l�I"I CONSTRUCTION <br /> VeWIPremise Address: �Z`( Sir" Total Depth <br /> �1 Screen Length (from) (to) <br /> Well No.: Sr U 15 W��-I y VVJ-3 Filter Pack (from) (to) <br /> /AON�( Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> M D r <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> Consultant height <br /> T <br /> Geologist Vh M 4 <br /> CFffilSTY80X <br /> Z� D 38 38 COMPl4TK)N CCMPLE ICN <br /> SPECIAL PERMIT INFO. gcY GroundSuAan <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft <br /> If yes, location and distance - <br /> tt. <br /> — e <br /> — c <br /> SAMPLING sic <br /> "clan —_ <br /> Holding Temperature = 9n1,W Park <br /> Method w = <br /> Screening Method , — <br /> Tracking Sheet - (y/n) <br /> tt. = tL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING N0 C)'\6 Y, Bags cement <br /> �^ <br /> SBuckets bentonite <br /> Depth to water so 6� Bags sand/gravel <br /> Mix Ratios SV,�k Filter Pack type/size <br /> Installation Method � kr Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> EH 29 29 - 'j - <br /> I VVV-3 Type of method <br /> 15 r i I Z2( Oi <br />