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OPNITORING WELL INSTALLATION REPCO <br /> Date: /Y/� N -21 CONSTRUCTION <br /> Premise Address: !�� S /rvif� Total Depth '7 / <br /> Screen Length (from) (to) <br /> Well No.: �J �' Filter Pack (from) (to) <br /> Bentonite (from) (to)��_ <br /> Inspector: Grout (from)---'�=(to)_� <br /> Drilling rig type <br /> Permit No. (5RQ�s�S -71 Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Co/m//pany: ✓��9�/ �Y•�/9AA '/Ji Lre <br /> Driller: 111 casingheightConsultant// //!/ <!/ lG 'i2(��!?f WT <br /> Geologist r�' e jjr& [ <br /> ABOVEGROUND CHRISiY480X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sutace <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) 17(0' 5 — XA- ��'^� 1 k. <br /> If yes, location and distance - V7 3 <br /> tt. <br /> aCl Sip /`Y <br /> — o <br /> SAMPLING slotted = 8 <br /> tec�on <br /> Holding Temperature - gmyd Pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROLiTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />