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_JNITORING WELL IriSTALLAMN RF-PC <br /> N L <br /> Date: ��,. jj CONSTRUCTION <br /> Premise Address: 31bus '' %1 Total Depth__ <br /> Screen Length (from) (to) <br /> Well No.: �`'L� Filter Pack (from) -(to)— <br /> P 1P <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Permit No. <br /> S�,*61 -7 Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: /i <br /> n,,✓J4- Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant �j <br /> _� -E <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CNRISTY-BOX <br /> SPECIAL PERMLt INFO. Ground Surface COMPLETION <br /> Distance to s er line Grout <br /> Domestic we on site - (y/ n ) <br /> If yes, locati n and distance - ft. <br /> . ft. <br /> ft. <br /> = m <br /> p <br /> SAMPLING = <br /> ribttad : — c <br /> toclon :"i <br /> Holding emperature _ P <br /> Method = <br /> Screen' g Method = <br /> Tracking Sheet - (y/n ) JI ft. <br /> SPOILS <br /> Storage ethod MATERIALS/DEVELOPMENT <br /> Cont enation Noted - (y/ n ) Ae IV <br /> �� <br /> Storage Location Casing type L?- / <br /> Blank ft. Screen ft. <br /> Slot size V r6 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 2 D I Bags sand/gravel <br /> Mix Ratios4--c Filter Pack type/size <br /> Installation Method_ Surge Block: - (y/ n ) <br /> Quantity Installed C'- 3y ,�, �� Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />