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MONITORING WELL INSTALLATION REPORT <br /> Date:"/7 CONSTRUCTION <br /> Premise Address: 1-00 t� l � Total Depth <br /> II// Screen Length (from) e f*) (Co) b <br /> Well No.- 41 -Z� v � Filter Pack (from) 3,0 (to) ?=� - <br /> V Bentonite (from) (to) ZS <br /> Inspecton.. s"'� P Grout (fro (to) <br /> Drilling rig type <br /> Permit No. (l J Auger O.D. I.D. <br /> (., Co on -' to e/christie box (circle one) <br /> Drilling Company: '� "9j."___- \ <br /> carp, ng <br /> Driller: height <br /> Consultant + <br /> Geologist 127/),5 C VG-GaC4JND q-RS7y.3�X _ <br /> WAPLEnON <br /> SPECIAL PERMIT INFO. - nd S 'c' <br /> prat <br /> Distance to server line / <br /> Domestic well on site - (y/ n ) _S_w__R. <br /> if yes, location and distance - 72 <br /> V4 O <br /> O <br /> O <br /> SAMPLING dar�i <br /> socicrn <br /> Holding Temperature <br /> Method -> <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) N <br /> Storage Location Casing type Pel/ ft. <br /> Blank 3J ft- Screen J <br /> Slot sizef9/ <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Miz Ratios Filter Pack type/size L 1 <br /> dttstallation Method Surge Block: - (y/n) <br /> Quantity Installed > Discussed vrith geologist: - (y/ i� <br /> Type or --------- <br /> EH <br /> ncthod —EH 29 29 <br />