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ONITORING WELL INSTALLATION REPCO <br /> Date: q/717 ? CONSTRUCTION <br /> Premise Address: o y Total Depth 's <br /> Screen Length (from) 41,7' (to) ?r-1 <br /> Well No.:_ _ _ 1 %"� Filter Pack (from) '17'' (to) --Y <br /> Bentonite (from) 7,5Y 1 (to) ?- <br /> Inspector: <br /> Inspector: //i!/I> Grout (from) 2-5-' (to) .. ti F4cti- <br /> Drilling rig type �j— ' <br /> Permit No. Auger O.D. ` '' I.D. <br /> Completion - Stove pipe c iristie o circle one) <br /> Drilling Company:_� <br /> Driller: 5 �t' Tcasing <br /> 1' height <br /> Consultant JYL,t t'ci7 V <br /> 7/49 Geologist 'A�% -- <br /> ABCVE-GACJND <br /> CCMPLET{ON CNASSTY-80X <br /> COMPLEMN <br /> SPECIAL PERMIT INFO. C3round SuAacs <br /> Distance to sewer lineaf0f� <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - it. <br /> o:• � M <br /> C <br /> SAMPLING M <br /> s4cicn •• "' <br /> B <br /> Holding Tempe tune <br /> Method C _ <br /> Screening Method <br /> Tracking Sheet / n ) <br /> ft. V <br /> YZ-ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( r <br /> Storage Location C-' iJ Casing type .Z <br /> Blank 3Z` ft. Screen f�"� ft. <br /> Slot size > C 11,.� <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size :--f i&? .Se <br /> Installation Method Surge Block: <br /> Quantity Installed Discussed with geologist: -6—Y n ) <br /> Type of method <br /> EH 29 29 <br />