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MG' 'ORING W1rLL INSTALLATION REPORT <br />a <br />i <br />Dace: � C r� 2 CONSTRUC'T'ION <br />Well No.: <br />— <br />Premise Address: Total Depth <br />Screen Length (from) (ro) ` <br />Well No.: S(0 Filter Pack (from) (to) <br />Bentonite (from) (to) <br />� <br />Inspector. : Grout I (from, _(to)�._ <br />Drilling rig type <br />Permit No. —� �l ~ 306 a Auger Q.D. II I.D <br />Completion -Stave pipe/ tie box circle one) <br />Drilling Company. <br />R <br />CONSTUCTION <br />Driller: zJ` w.1-1 <br />..Consultant <br />Total Depth <br />Screen' Length (from) (to) <br />gl Filter Pack (from) (to)—BEE <br />Geologist Bentonite {from) 2 (to) �7 <br />Grout i {from) D (to)D <br />SPECIAL PERMIT INFO. <br />i10 <br />Distance to sewer line <br />Domestic well on site - ( y / xU <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature , <br />Method "� I <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPOILS <br />Storage Method <br />Contamination Noted - ( y / n. } <br />Storage Location <br />GRUMNG <br />Depth to water <br />Mix Rados <br />Installation Method <br />Quantity Installed aeA <br />EH 29 29 <br />rig <br />Auger <br />pipe/chris ' ox (circle one) <br />Well No. nlVW <br />Total Depth 1R I <br />Screen Length: (from) <br />Filter Pack ;(from) <br />Grout 11 I [from) x U <br />Drilling ng type <br />Auger O.D. it LD — <br />rmmnt.ifinn . Stove of e/christie bo circle one) <br />Slot. <br />Bags <br />nice <br />`' Pc/G <br />Bags sand/Zvcl <br />Filter Pack type/size <br />Surge`Bloc-IL ( y / n } <br />Discussed with geologist: - ( y / n ) <br />Type of method <br />