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�NITORING WELL INSTALLATION REPCO <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) Ct0) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: T casing <br /> T he±qht <br /> Consultant <br /> Geologist IVF-GRAD CHRZIT•Y-80X <br /> CCh�I�°T10N CCMPLEnCN <br /> SPECIAL PERMIT INFO. � Surfsa ��— <br /> prout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - h- <br /> tt. <br /> = o <br /> SAMPLING tbrti c <br /> axion =_ <br /> Holding Temperature = gMV'W G& <br /> Method =M = <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 Screen ft. <br /> Blank ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />