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0;E 3 OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: / 3 - <br /> "/// <br /> CONSTRUCTION��f 2 <br /> Premise Address:-- "�` ° 72c� 5;/C]�-fn Well No. 1 IL✓ 116 �Z- .6 <br /> Inspector: Total Depth `/S <br /> �J f- Screen Length `1 -3 5 ' <br /> Filter Pack mss- 3 ( <br /> Bentonite Pellets 3 ( - '30 <br /> Permit No. �U' 3 2� Grout 3 U-/ <br /> Consultant Completion-Stove pipe ristiebox <br /> Geologist ::52'7-1 • <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature atkk-up <br /> Method <br /> Screening Method <br /> ABOVE-GROUNO CHRISTY-BOX <br /> Tracking Sheet (yl_65 COMPLETION COMPLETION <br /> .�.�Ground S <br /> SPOILS <br /> // // grout <br /> Storage Method �� 045 AC <br /> Contamination Noted -(]ho �fl. <br /> Storage Location ��// TM <br /> = m <br /> a <br /> SPECIAL PERMIT INFO. — r <br /> o <br /> ��/ slotted <br /> Distance to sewer line actlon <br /> Domestic well on site - ye o r; <br /> If yes, location & distance - ` <br /> rt <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type <br /> Mix Ratios Blank ft. Screen /;f2--ft. <br /> Installation Method Slot size C-)2— CD <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />