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NITORING WELL INSTALLATION REPOP <br /> Date: /7- Lr 2 2-2 /2-0 1/ CONSTRUCTION <br /> Premise Address: / , 977. W Total Depth D <br /> S r q Screen Length (from) (to) <br /> Well No.: G GV�U`� f o� �� - �i 1'W�� I Filter Pack (from) i (to) <br /> SD Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. (0 Auger O.D. (T- I.D. <br /> Completion; Stove pipe/cluistie box (circle one) <br /> Drilling Company:(71L.'> <br /> Q Q <br /> Driller:tX/►"^a �� 'ti casing <br /> 1, height <br /> Consultant e�--A <br /> Geolo 'st -( <br /> gt .. <br /> ABOVE-GROUND CHRtM43OX <br /> CCMRLZrCN CCMPL-EnCN <br /> SPECIAL PERMIT INFO. Ground Sulact <br /> Distance to sewer line t1LA, aroul <br /> Domestic well on site - ( y n ' ' ft. <br /> If yes, location and distance ft. <br /> C <br /> SAMPLING <br /> i/OC sacycn _ <br /> Holding Tempera�t re Z/ <br /> Method 5 S t ' — ¢"'9r pack <br /> Screening Method A✓ <br /> Tracking Shcet - y n ) <br /> — -�=—n• — ft. <br /> SPOILS f 10) W� <br /> Storage Method NIS MATERIALS/DEVELOPMENT <br /> Contamination Not d - ( y ) <br /> Storage Locatioa- Casing type �� lei S• <br /> `T'- Blank /rft. Screen O ft. <br /> Slot size C9.O/O <br /> GROUTING Bags cement • C 17 <br /> Buckets bentonite from <br /> Depth to water'` ! r b Bags sand/gravel—5'—'0 rr <br /> Mix Ratios Filter Pack type ze `Z � <br /> 1' <br /> Installation Method e� Surge Block: - / 11 ) <br /> Quantity Installed Discussed with geologist: �/ n ) <br /> Type of method_ <br /> EH 29 29 <br />