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NITORING WELL INSTALLATION REPOP <br /> Date: d�Z0 �V 0 CONSTRUCTION <br /> Premise Address: �� /� O'�' I�� Total Depth 30 <br /> , QQ Screen Length (from) 2-Y (to) 8 <br /> Well No.: Filter Pack (from) 30 (to) (p <br /> Bentonite (from) (o (to) l <br /> Inspector: Greu� (from I (to) O <br /> S�/y Shc Drilling rig type (ol <br /> Permit No. Auger O.D. Is I.D. <br /> � /y Completion - Stove pipe/christie bo (circle one) <br /> Drilling Company: <br /> Driller: ba^ f casing <br /> � ^ height <br /> Consultant � � / // <br /> Geologist �C �U&e-�y <br /> ABOVE-GfiCUNO CNALSiY BOX <br /> COMPL�bN COMPLETION <br /> SPECIAL PERMIT INFO. Grourd Surface ny, <br /> Distance to sewer line /3G °P"F �y,I'� K <br /> Domestic well on site - y n ) <br /> n <br /> If yes, location and distance - <br /> g n. <br /> — m <br /> — o <br /> = m <br /> SAMPLING slotted = '' <br /> &action — <br /> Holding Temperature = f <br /> ack <br /> Method <br /> Screening Method = " <br /> Tracking Sheet - (y/ n ) <br /> SPOILS �Q <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) r r ) _ p✓C <br /> Storage Location Casing type 2 `K� / <br /> Blank $ ft. Screen LO ft. <br /> Slot size �1C7 <br /> GROUTING Bags cement <br /> Buckets bentonite Z <br /> Depth to water r) Bags sand/gravel �oC <br /> Mix Ratios Filter Pack type/size 2 <br /> Installation Method Surge Block: - (y(F) <br /> Quantity Installed Discussed with geologist: - (y C)) <br /> Type of method <br /> EH 29 29 <br /> 3,- LR-1 <br />