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ONITORING WELL INSTALLATION REPCO <br /> Date: I I 'z 'g l CONSTRUCTION <br /> i <br /> Premise Address: FORK /106ertT Total Depth /4J <br /> Screen Length (from) (to) <br /> Well No.:— Filter Pack (from) (to) <br /> D,S <br /> Bentonite (from) /—Zoe (to) <br /> Inspector. S GCWN 0 co, � Grout (from) //5.S (to) <br /> Drilling rig type <br /> / � <br /> Permit No. 1//��� � � Auger O.D. <br /> Drilling Company_ Nr ��L�12 /Y�« C [dVG> Completion - Stove pig/chrisde box (circ <br /> Driller: �l casing <br /> 7 X <br /> Consultant /'n�'moi 13y3 4:1�/I✓G4'ti Lea-) height <br /> T <br /> Geologist s '� r�L✓-rr_4L 7 —QV <br /> -F <br /> COWLETION CHRZTY-80X <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surlacs <br /> Distance to sewer line 1 SD r pfout <br /> Domestic well on site - (y <br /> If yes, location and distance - <br /> n n. <br /> v m <br /> = o <br /> = c <br /> SAMPLING dorsad <br /> soc'cn <br /> Holding Temperature_. U /� <br /> Method — gr'vai pack <br /> Screenin-Method <br /> Tracking Sheet - (y/ n ) <br /> Vii;: — <br /> SPOILS <br /> Storage Method AJ Lll-e- MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Locationyi/ E5S7L8FS Glit- Casing type SC)-($u PUC- <br /> Blank <br /> UGBlank /ZS ft. Screen 20 ft. <br /> Slot size U,U/ <br /> GROUTING Bags cement / f G 071cTy- <br /> Buckets bentonite / G <br /> Depth to water " 3S Bags sand/gravel 5 <br /> Mix Ratios / _�2I lU l� TtS H4 Filter Pack type/size 3 <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed x,70 6/n5 Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />