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*NITORING WELL INSTALLATION REPCO <br /> Date: ///1 CONSTRUCTION <br /> Premise Address: 7.f O ,,� ,.ta Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Inspector: W&-U114 Bentonite (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> _ casing <br /> Consultant <br /> �nT <br /> height <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CIiRZTY-BOX <br /> SPECIAL PERMIT INFO COMPLETION <br /> Ground Surtacn <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance <br /> ft ft. <br /> _ a <br /> = o <br /> SAMPLING c <br /> dorw — c <br /> Holding Temperature a°c9On = <br /> Method _ graw Pack <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) <br /> ft. ft. <br /> SPOILS <br /> Storage Method <br /> Contamination Noted - (y/ n ) MATE��S/DEVELOPMENT <br /> Storage Location Casing type <br /> Blank ft. Screen h, <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed Surge Block: - (y/ n ) <br /> Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />