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-INITORING WELL INSTALLATION REPOP— <br /> Date: 1z CONSTRUCTION Well No.:CC f <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: OmA2 52 Filter Pack (from) (to) <br /> Bentonite (from) (to) I C5 <br /> Inspector: : Grout (from) 3 (to) e!�_? <br /> Drilling rig type <br /> Permit No. ��` �3 c�- 40` Auger O.D. <br /> Completion - Stove pipe/ zr tie box ircle one) <br /> Drilling Company: II ;; <br /> Driller: CONSTRUCTION Well No.: W S - <br /> Consultant Total Depth <br /> r Screen Length (from) (to) _ <br /> Geologist NWCA, Filter Pack (from) (to) <br /> Bentonite (from)_ --2,5 _(to) <br /> 4— <br /> Grout (from), 37 - <br /> SPECIAL PERMIT INFOr Drilling rig type <br /> Auger O.D. I.D. <br /> Distance to sewer line Completion - Stove pipe/chrisde box (circle one) <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> CONSTRUC 70N Well No.: <br /> Total Depth <br /> Screen Length (from) (to) ,_ <br /> Filter Pack (from) (to) <br /> SAMPLING Bentonite (from) (to) <br /> Grout (from) (to) --_, <br /> Holding Temperature Drilling rig type <br /> Method Auger O.D. I.D- <br /> Screenina Method Completion- Stove pipe/chrisde box (circle one) <br /> Tracking Shcet - (y/ n ) <br /> SPOILS <br /> Storage Method 6 S MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y 4n <br /> Storage Location ming type <br /> Blank fr- Screen �- <br /> Slot size <br /> GROLMNG Bags cement <br /> j Euckets bentonite <br /> Depth to water -"- 5 Bags sand/gravcl <br /> Mix Ratios S Filter Pack type/size <br /> Installation Method ry.a 2 Surge Block: - (y/0 <br /> Quantity Installed 3 Discussed with geologist: - R/ n) <br /> Type of method <br /> EH 29 29 <br />