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NITOFUNG WELL INSTALLATfONREPOF <br /> Date: 3.3 _CONSTRUCTION <br /> Promise <br /> Total DepthScreen Length (from)—U_2 (to) 4 <br /> Filter Pack (Ecom)Well Bentonite (from)- (to) bn <br /> Grout (from) (to) <br /> Inspector: <br /> Drilling rig type <br /> u <br /> Permit No. Auger \��T <br /> Completion - Stove pip stle (circle one) <br /> Drilling Company:_A&�-V�L <br /> Driller: 9, casing <br /> height <br /> Consultant <br /> T <br /> Geologist A�;VE-GFIWNO CHRPM-BOX <br /> COWLEVON COMPLETIGN <br /> SPECIAL_PERMT INFO. <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y I n <br /> if yes, location and distance - fld <br /> SAMPLING oto <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet ny n Q-1 <br /> SPOILS <br /> P� MATFRJALS/rDEVELOPMENT <br /> Storage Method <br /> Contamination Noted y n <br /> Storage Location qCasing type <br /> d- V(- � <br /> Blank ft. Screen— 2 -ft. <br /> Slot size 011 <br /> Bags cement <br /> ' l <br /> ucket—s <br /> cntonite <br /> S gsksan"e7gravel <br /> Depth to water aIC <br /> typ e/s I Z C., <br /> Mix Ratioe--- <br /> V ge Block: <br /> insttilliuici Metbnd____jQfj _V Discussed with geologist: n <br /> Quantity Installed <br /> Type of tued-lod—lq A�_ <br /> 01-ILL <br /> EH 29 29 <br />