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ONITORING WELL INSTALLATION REPCO <br /> Date: 2 - `LCo ' q2-- CONSTRUCTION <br /> I <br /> Premise Address: I ZSD 6 . LX47b40t0 Total Depth ZS <br /> Screen Length (from) (to) !O <br /> Well No.: MUD -S Filter Pack (from)-(to) <br /> Bentonite (from) (to) C <br /> Inspector. S. `�Ck41J13Y7Ls� Grout (from) (o (to) 'e- <br /> Drilling rig type <br /> Permit No. G2 - 3l2 Auger O.D. I.D. R2 <br /> I Completio Stove pipe c uistie box circle one) <br /> Drilling Company: <br /> Driller: IJP{ LUM casing <br /> height <br /> Consultant Ali gmP a.)e-\0 YV <br /> -� <br /> Geologist �1V'V4 a T <br /> ABOVE-GROUND Ci4i15TY 80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Satan <br /> trout <br /> Distance to sewer line �r�D l,�tl"1� OO C <br /> Domestic well on site - (y/ n ) ftlxCalLfoe-Ft <br /> If yes, location and distance - �Lt�1Gt ptJ�{(S g <br /> a <br /> _ . <br /> SAMPLING doroi <br /> Holding Temperature 40C- " <br /> g"Vol Pack <br /> Method 5 _ _ <br /> Screening Method <br /> Tracking Sheet - (y / n ) `F: <br /> tt. _ }t. <br /> SPOILS <br /> Storage Method P-1 -De tjKe, MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Ie <br /> Storage Location nlJ Sl'[C57 Casing type Z SC44- 4D PV G <br /> Blank Ilo ft. Screen f5 ft. <br /> Slot size . D2n <br /> GROUTING Bags cement <br /> i Buckets bentonite U43 <br /> Depth to water 11 Bags sand/gravel <br /> Mix Ratios 8 La?jd S f'-�P+y Filter Pack type/size <br /> Installation Method9� Kcal_ Surge Block: - ( y/({}7) <br /> Quantity Installed 3 Discussed with geologist: - ((b/ n ) <br /> Type of method ls�A <br /> EH 29 29 <br />