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MWORING WELL INSTALLATION REPT <br /> Date: (2 CONSTRUCTION <br /> Premise Address: 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 /> U Sr Completion - StovIsli <br /> a/christie box (circle one) <br /> Drilling Company: <br /> Driller: PAL cng <br /> height <br /> Consultantr-)-q 0 UfA.,-- M -eVT <br /> Geologist ABOVE-GROUND <br /> COF.iPLETlON CHAISTY-80X <br /> COMPLEMN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) �=ft. <br /> If yes, location and distance - ft, <br /> ft. <br /> = m <br /> _ a <br /> SAMPLING +bttad <br /> a� sac-ion <br /> Holding mper Lirta _ gravel pack <br /> Method U <> <br /> Screening Me d > '— <br /> Tracking Sheet - (vp/ n ) <br /> SPOILS �) <br /> Storage Method ►" MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> BlankTbentonite <br /> Screen ft• <br /> Slot size <br /> GROUTING Bags ce <br /> Buckets Depth to water D Bags sanMix Ratios �i Filter PaInstallation Method Surge BlQuantityInstalled Discusse (y/ n ) <br /> Type of method <br /> EH 29 29 <br />