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MONITORING WELL INSTALLATION REPORT <br /> Date:'hK CONSTRUCTION <br /> Premise Address: 49 64y, Owy 4V&yt4.j Total Depth <br /> Screen Length (from) lgo'P, (to) 2oa <br /> Well No.: 4W-A' Filter Pack (from) '3v3I-. <br /> Bentonite (from) If,G +• (to) f ao f• <br /> Inspector: ohm/ oRI�NM Grout (from) SUn.ac (to)_ f <br /> Drilling rig type Ver5., V-/060(,7 <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: Gi"" d2►�LfNN <br /> Driller: &Q Z� ja PJAVAs casing <br /> A 2c r `n C S U,5. T ♦ height <br /> Consultant nC <br /> Geologist Q d dc'1 qo F rva u G <br /> ABOVE-dROUND <br /> C�fr LL ii}ON C�-{R157Y�OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sufacs <br /> Distance to sewer line N a grout <br /> Domestic well on site - (y <br /> If yes, location and distance - n <br /> I�0 ft. ft. <br /> = m <br /> = m <br /> SAMPLING = <br /> alottad — � <br /> N svc�on <br /> Holding Temperature = <br /> Method <br /> Screening Method _ <br /> Tracking Sheet - (y/n) _ <br /> A00 ft. `= _ <br /> ft. <br /> SPOILS .��_f+. <br /> t� I ,1 -_ <br /> Storage Method `o,of r "►b yJ• rollh i n MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/©) �a. <br /> Storage Location 01►-S I�t �Nlw werV 10JO) Casing type StkeJu lC 90 <br /> Blank 0 ft. Screen Z0 ft. <br /> Slot size 0 <br /> GROUTING Bags cement <br /> Buckets entonite e4s1� u <br /> Depth to water Jn Bags san gravel O Ih. 4 <br /> Mix Ratios Filter ack type/size ScmJ <br /> Installation Method Surge Block: - (©/ n ) <br /> Quantity Installed Discussed with geologist: - �y/ n ) <br /> Type of method <br /> EH 29 29 <br />