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O)AGE �--OF <br /> MONITORING WELL INSTALLATION REPORT. <br /> Date• � 7A CONSTRUCTION <br /> Premise Add s: ILLI) CEJ" - Well No. ki W <br /> Inspector: Total Depth 3 a1 <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets S <br /> Permit No. Grout S <br /> Consultant .T Completion-Stove pipe/c pistie b x <br /> Geologist <br /> Auger O.D. /,V <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature � atidc-up <br /> Method 12A ei <br /> Screening Method <br /> ABOVE-GROUND CHRISiY-BOX <br /> Tracking Sheet y n) COMPLETION COMPLETION <br /> Ground Surface �---�� <br /> SPOILS <br /> grout <br /> Storage Method ��GJLLr <br /> ON <br /> Contamination Noted - yes nft' <br /> Storage Location <br /> ft. <br /> o <br /> SPECIAL PERMIT INFO. c <br /> _ o <br /> sb slotted <br /> Distance to sewer line section <br /> Domestic well on site - yes/nogra�ef pack <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water �� Casing type' <br /> Mix Ratios Blank Ll' ft. Screen ft. <br /> Installation Method Slot size 1 _ <br /> Quantity Installed . ZS N4S. Bags cement <br /> Buckets bentonite'Z S6WI t <br /> Bags sand/gravel f <br /> Filter Pack type/size S �� <br /> Total Billed Time Per Site . <br /> Date Permit Finalized <br />