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MCIORING WELL INSTALLATION REPORT <br /> Date: ```� CONSTRUCTION <br /> Premise Address: 7Y� Total DepthS7 <br /> Screen Length (from) 7 (to). 3 T <br /> Well No.: ��� Filter Pack (from) 15'7- (to) 3 <br /> Bentonire (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type -6 <br /> Permit No. /L T� Auger O.D. /0//z ID._ <br /> Completion - Stove pipe/chrstie box (circle one) <br /> Dre ling Company <br /> =. ,. casing <br /> Driller: �� �� L height <br /> 75 Consultant <br /> Geologist <br /> ABOVEiaWND CtASdCX <br /> "^&VL CN CCPiC <br /> G=r)d SU12C. <br /> Sperlar PER'vtlT INFO. <br /> grout <br /> a <br /> Distanceto sewer line tt <br /> Domestic well on site - ( y <br /> If,yes, location and distance • g <br /> 4 <br /> o <br /> O <br /> SAMPLING wcion : —_ <br /> IfivW pack <br /> Holding TempeA ttur Oft GGA _ i <br /> Method <br /> Screening 4tethod ! s; <br /> Tracking Sheet - n ) 57 tt ♦ - tt. <br /> SPOILS <br /> StorageMerhod 1L� MAieRIAL.S/DEVELOPNM <br /> Concamination Noted - y ) � <br /> Storage Location D�l N" <br /> Casing type <br /> At <br /> Blank 37 ft. Screen ?O ft <br /> Slot size -OZ <br /> - <br /> GROUTING Bags cement <br /> Buckets bentonite L <br /> Depth to water !Z' 7 3 Bags sand/gravel <br /> Mix Radas Filter Pack typesize <br /> lnstallacion Method Surge Bloc - (;= <br /> Quanc y Installed Discussed with geologist- - �+ n ) <br /> Type of method /✓�i� <br /> 1/014Y A X11940 <br />