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NITORING WELL INSTALLATION REPOR J <br /> Date:-A111/11 --- CONSTRUCTION <br /> Premise Address: S 7 / I —S1 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stave pipe/christie box (circle one) <br /> Drilling Company: u 0V <br /> Driller: casing <br /> 17LTheight <br /> Consultant- T <br /> T <br /> Geologist— <br /> A80VE-GROUND C-R*SCY4= <br /> CONN ETCN COMPLETION <br /> SPECIAL PERMIT INFO. around Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) �ft. <br /> ifyes, location and distance - n, <br /> tt. <br /> ;ry <br /> a <br /> SAMPLING slotted <br /> section `Y"'" � <br /> Holding Temperature .N — <br /> 4R�P� <br /> Method <br /> Screening Me <br /> Tracking Sheet - (y/ n ) %. — <br /> tL <br /> SPOILS <br /> Storage Method Po MATERIALS/DEVELOPMENT <br /> Contamination Noted - Q1 n ) <br /> Storage Location Casing type <br /> Blank ft- Screen h. <br /> Slot size <br /> GROUTING Bags cement <br /> l Suckers bentonite <br /> Depth to wateM 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 />