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�. .ORT <br /> YOKING WELL INSTALLATION i .. , <br /> 7111 <br /> CoOo� (sea Dd �u . ;. <br /> c�G U <br /> CONST N <br /> Date: <br /> 2 4 C ,P� Total DLen 25, <br /> Premise Address: Screen Length (from) 2�—Cto) l <br /> Filter Pack (from) _--T— 0 <br /> Bentonife• Cfrom)' ��--.(t ) <br /> A TT— <br /> Well No.:. (from)BV Pt <br /> YMA17 e 1m�1ecC� ( r� <br /> Inspector: { Drilling ng tyP --�I.D. I U <br /> Auger O.D. 1__5 circle one) <br /> Permit No. S Completion-Stove pipe stie o C <br /> Drilling Company: Y casing <br /> //�� bU IQ.vC.�VlS�) height <br /> Driller: q �,>—+ LZLY�Li cac — y <br /> Consultant 1 <br /> .D ABOVE-GROUND <br /> Geologist pNPLEf ON ON S <br /> { <br /> SPECIAL PERMIT INFD. orcut <br /> Distance to sewer line <br /> If yes, location and distzn <br /> m <br /> � Ila_ <br /> S NG . 3�2 'it& son <br /> 1`s�t l9•S :' = pnvel pact <br /> Tem erature �} <br /> Holding P 2 x..010 <br /> Method <br /> Screening Method <br /> Tracking Sheet - C Y�n) ft. <br /> SPOILS Mp ;P1ALS/DEVELPMENT O <br /> j GQrcc alp 17VG <br /> Storage Method <br /> Contamin, on Noted- n) Casing type <br /> Blank 1 Screen ft' <br /> Storage Location Slot size 0 , _ isfl <br /> �S <br /> Bags cement T1 a r2 (x� bUcJ� <br /> GR_�CT Buckets bentomt <br /> ✓` ' 5, <br /> 1 D Bags sand/gravel.. `f ra <br /> O• ivy <br /> Depth to water _ 1(� Filter pack type/size <br /> i <br /> Mix Ratios S,jtirge-Block:_(.Y--/ <br /> Discussedwith geolpgist: <br /> Installation Method K &-nu4 ,�- Type of method i c <br /> Quantity Installed <br /> EH 29 29 <br /> �cu,,,c.0✓O S f�- <br /> 11�� W tyL'�,Gat.rn� i <br /> 1C rxuEx ZS <br />