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ONITORING WELL INS ON REPS <br /> // CONSTRUCTION <br /> Premise Address: �/• �r4.';4 �f Total Depth <br /> 04 Screen Length (from) (to) <br /> Well No.: A\ 'l Filter Pack (from) (to) <br /> Bentonite <br /> Inspector: �Luzy Grout (from)( to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant 1711 <br /> Geologist T <br /> ABOVE-GROUND CHAISTY BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. proutd Saian <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> tt. <br /> A <br /> Y' 0 <br /> SAMPLING <br /> 0 <br /> cloned = Z <br /> tedce <br /> Holding Temperature <br /> Method _ vf1°lPaCK <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) _ <br /> n. = tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) �A <br /> Storage Location Casing type Nbl <br /> Blank v fr. Screen fr. <br /> Slot size <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 /> EH 29 29 Type of method <br />