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REPOMONITORING WELT.INSTALLATION REP <br /> Date: CONSTRUCTION <br /> Premise Address: 2� C -� 5 Total Depth / <br /> Screen Length (from) _ (to) f� <br /> Well No.: — Filter Pack (from) Z�K (to) '2z' <br /> Bentonite (from) !�E(- (to) '3 <br /> Inspector: -j G Grout (from)_ s3 (to) <br /> Drilling rig type 15`34 <br /> Permit No. z-,? 7,e z-/ Auger O.D. -� I.D. rr <br /> Completion - Stove pipe fur � (circle one) <br /> Drilling Company: <br /> Driller: � I� <br /> casing <br /> height <br /> r77 V <br /> Consultant J <br /> Geologist M <br /> ABOVE-GROUND CHRZTY-BOX <br /> OOMPLFTCN COMPLE'nON <br /> SPECIAL PERMIT INFO. G=nd Surf=* <br /> Distance to sewer line Qf°� <br /> Domestic well on site - (y/d-0 <br /> If yes, location and distance - ft. <br /> tt. <br /> "a m+i <br /> 0 <br /> O <br /> SAMPLING slot:*.i w: _ <br /> sacicn <br /> Holding Tempera a V"Pack <br /> Method G S S "s <br /> Screening Method rw = <br /> Tracking Sheet - ( y/ n ) _ <br /> SPOILS <br /> Storage Method MATEMALS/DEVELOPMENT <br /> Contamination Noted - (y/ <br /> Storage Location Casing type <br /> BIank Sof ft. Screen 20 ft. <br /> Slot size -2-0 <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 />