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ONITORING WELL INSTALLATION REPCO <br /> 9&14/e o <br /> Date: S�/G� CONSTRUCTION <br /> Premise Address: Ncp /�ol ✓ Total Depth <br /> Screen Length (from) / 6 (to) /G <br /> Well No.: 5�2 lAC �/ �✓yG� Filter Pack (from) le / (to) <br /> Bentonite (from) /`d S (to) /3 S <br /> Inspector: Grout (from) / 3G 5 ) !2) <br /> o ©c R Drillin rig type ✓�✓t� Ko�iY <br /> Permit No. � V l� QQ� er O.D. /'Z- I.D. <br /> Y3"� Completion - S circle one) <br /> Consultants <br /> Geologist e� stIck-up <br /> SPECIAL PERMIT INFO. ABOVEGROUND <br /> COMPLETION CHRISTY-BOX <br /> Distance to sewer line COMPLETION <br /> Domestic well on site - (y Ground S <br /> If yes, location and distance - Otout <br /> n. <br /> tt. <br /> SAMPLING '^ — ;. • <br /> o <br /> Holding Temperature dcdad -, <br /> Method mon <br /> Screening Method = '. gmW pack <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Notes - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size � D <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ n ) <br /> Installation Method Discussed with geologist: - ( y/ n ) <br /> Quantity Installed Type of method <br />