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U-01NITORING WELL IN�7 REPCU <br /> I t -,VkN EL *,F t <br /> Darj, WO// ' &Li3 boo a,1�' <br /> CONSTRUCTION <br /> Premise <br /> Address:;Z VIJ Total.Depth <br /> Well!No.: Screen Length (frcVm)_(to)_ <br /> Filter Pack, (from) (to) <br /> I' 4i, Bentonite (frorrr) (to) <br /> Inspe"ctor: 11—Uluw Grout (from) (to) <br /> Drilling ng type <br /> Permit No. �e)o�;2-Y3(&, <br /> Auger O.D. I.D. <br /> Completion�- Stove pipe/christie box (circle one) <br /> Drilling <br /> rN <br /> Driller: <br /> casing <br /> height <br /> I:VX <br /> Consu�ltant <br /> Geologist <br /> ABOVE-GR D <br /> aGR <br /> V <br /> CONWVLETIC <br /> SPECIAL PE T INFO, C PLETI <br /> ' <br /> Distance to 'selwer line grout <br /> Domestic well on site - (y n <br /> If yes, location and distance - <br /> ft <br /> h. <br /> Z- <br /> SAMPLING <br /> on <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracki ng Sheet' - (y/ n ) <br /> —tt. <br /> bFULL5 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination' Noted - y n <br /> Storage Location Casling type <br /> I <br /> Blank- ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> lt� t3 Buckets bentonite <br /> Depth to water Ba'g's sarid/gravel- <br /> Mix Ratios IV-(-A4- Filter Park type/size <br /> Installation Method /AAA-1- Surge Block: y/ n <br /> Quantity Installed Discussed with geologist: y n <br /> Typeof method <br /> yp <br /> EH 29 29 <br />