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�NITORING WELL INSTALLATION REPCA <br /> Date: 'GONSTRUcnON1 <br /> Premise Address: Total Depth Pit <br /> Screen Length (from) (to) <br /> Well No. Filter Pack (from) <br /> Bentonite <br /> Inspector• J/O drour (from) S to <br /> Drilling rig type � V <br /> Permit No. Auger O.D. I.p�' e <br /> / <br /> Completion St �p ov�-�ipe/christie box {circle one) <br /> Drilling Company: <br /> Driller: SG -� ctaa i.n$ <br /> height <br /> Consultant �• 2 <br /> Geologist 5'�' <br /> • OOAiPLETtONCOMPWTM <br /> SPECIAL PERMIT INFO. b Ground Skrfwe �...� <br /> Distance to sewer line <br /> Domestic well on site - (y/n) . <br /> If yes,location and distance - -j—�--�-- <br /> tL <br /> SAMPLING <br /> slonsd <br /> secdon <br /> Holding Temperature <br /> Method ��_..� _ P <br /> ack <br /> Screening Method <br /> Tracking Sheet T1 n) ' <br /> SPOILS <br /> Storage Method MATERIALS/DMMLOPMENT <br /> Contamination Noted - (/�/ n ) <br /> Storage Locationy `� /j�tic-Z Casing type T <br /> Blank ft. Screen ( S-" h. <br /> SIot size D .O.- ' <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method A,A4 Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - (q/n) <br /> Type of method <br /> EH 29 29 <br />