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ViIONITORING WELL INSTALLATION REPORT <br /> Date: \\ l CONSTRUCTION <br /> Premise Address: 41 S• WIL5om I/ AH Total Depth 7 r <br /> Screen Length (from) h O (to) !�M <br /> Well No.: NAy], 2 Filter Pack (from) -10 ' (to) 4 Q,' <br /> Bentonite (from) 48' (to) 41' <br /> Inspector: f Dene Grout (from) 41 (to) 1 <br /> Drilling rig type jA .03 <br /> Permit No. Auger O.D. t" mic- To Io' .D. 4-Z$ <br /> Completion - Stove pip tie ox (circle one) <br /> Drilling Company: 6W_1& <br /> Driller: �J Tcasing <br /> T height <br /> Consultant fbIu.�INL�_�Lyrrb <br /> Geologist ,P<IJ �'106�In111� �- <br /> AE&E-GACUND CHRISrI gnx <br /> COWLL'-TION CN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line(1 k gra <br /> Domestic well on site - (y/ n) 4') ft. <br /> If yes, location and distance - i ft. <br /> ft. <br /> — _ m <br /> SAMPLING slottad = 'c <br /> sec cn W., '- <br /> Holding Temperature 4 �; __ gavel pack. <br /> Method _ <br /> Screening Method 1 I <br /> Tracking Sheet - V n ) <br /> _ft. �.._ -70' ft. <br /> SPOILS <br /> Storage Method Uum MATERIALS/DEVELOPMENT <br /> Contamination Noted- ( ) I <br /> Storage Location -(�N I Casing type Soe 40 a 1 <br /> Blank ft. Screen 1/0 ft. <br /> Slot size l0 <br /> GROUTING Bags cement <br /> is bentonite <br /> Depth to water Bags san gravelLO _. <br /> Mix Ratios Filter Pack typesize <br /> Installation Method IT 1A h I - Surge Block: - n) <br /> Quantity Installed Discussed with geologist: SC,_ )Type of method V6A L' <br /> EH 29 29 /m1� <br />