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'-MONITORING WELL INSTALLATION REPOW*i' <br /> Date: J /1b CONSTRUCTION <br /> Premise Address: i 27 159 C � Total Depth <br /> Screen Length (from)-AH (to) t� <br /> Well No.: Filter Pack (from) d (to) 7 9 <br /> Bentonite (from) 2-3 (to) ZI'/i <br /> Inspector. .0 Grout (from) <br /> q F Drilling rig type T <br /> Permit No. / l ' Auger O.D. I.D. ft VU <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Cojm��pany <br /> Driller: c< o�` casing <br /> ,Fheight <br /> Consultant t5+ <br /> -QVT <br /> Geologist z)4'je -- - <br /> ABCVE-fACUND C16i1STY48GX <br /> CCMPLETICN CCMMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Sudan <br /> Distance to sewer line Ln;A� grout <br /> Domestic well on site - (y n <br /> If yes, location and distanc - n. <br /> �LIt. <br /> — o <br /> SAMPLING <br /> p c� &*den eM — <br /> Holding Temperature _ a, <br /> Method /t/t x <br /> Screening Method 'I <br /> Tracking Sheety n) ����� ` <br /> —yyE41 = It <br /> SPOILS Q <br /> Storage Method 1Ss MATERIALS/DEVELOPMENT <br /> Contamination Noted - y tk- <br /> Storage Location It S Casing type <br /> Blank � Ul/z ft. Screen 1y ft. <br /> Slot size •02 o <br /> GROUTING Bags cement <br /> Buckets bentonite ,> <br /> Depth to water >`� z Bags sand/gravel 1i, <br /> Mix Ratios/ti Filter Pack type/size ? <br /> Installation Method Surge Block: -O n ) <br /> Quantity Installed Discussed with geologist: - / n) <br /> Type of method <br /> EH 29 29 <br />