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ir INSTALLA'T'ION REPOR•i <br /> Date: � CONSTRUCTION - <br /> Total Depth <br /> Premise Address: ��'�' ^ ' tvS <br /> S Screen Length (from) (to) <br /> Well No.. Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector Grout (from) to) <br /> ' Drilling rig type V <br /> Permit No, <br /> O d %12.5 Auger O.D. 'V.il& LDA56 <br /> �e Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �� -- <br /> casing <br /> Driller: 7_ height <br /> Consultant /� <br /> -W-F <br /> Geologist ABOVE-GRCUND <br /> COh�LET{ON CNAfST'Y-80X <br /> CpMPLEEMCN <br /> SPECIAL PERMIT I dFO. Gro"rd Surface <br /> grout <br /> Distance to seN r line <br /> Domestic wel on site - ( y/ n ) ft. <br /> If yes, loca ' n and distance - n• <br /> ft. <br /> _ o <br /> C <br /> SAMPLING j <br /> s@eticn _ <br /> Holdinf-Shcet <br /> perature KW Gw <br /> �. <br /> Metho = <br /> Screenthod `" _Tracki - ( y/ n ) _ <br /> SPOILS <br /> Storage Method A'k MA RIALS EVEI. MENT <br /> Contamination Noted ( y n ) <br /> Storage Location Casing typ <br /> Blank ft. Screen • <br /> Slot size <br /> GROUTING Bags cern t <br /> Buckets entonite <br /> Depth to water Bags nd,1gravcl <br /> Mix Ratios Filter Pack type/size <br /> Installation Method M11—ILL Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />