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MO,W TORING WELL INSTALLATION REPORT Nws,4' <br /> Date: !! - I- � CONSTRUCTION <br /> 6 t l[ �� (lid UG Total De th 4i <br /> Premise Address: � P <br /> Screen Length (from) ft (to) 2 <br /> Well No.: 5 Filter Pack (from) 4 ,5 (to) Z� <br /> `I Bentonite (from) 23 (to) ZZ <br /> Inspector: t�1►��8� Grout (from) ZZ_ (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. 1011 I.D. (v 8r' <br /> Completion - Stove pi hristie (circle one) <br /> Drilling Company: ��- � ��(1-1.1�J Cr <br /> Driller: t � casing <br /> height <br /> Consultant <br /> Geologist_ LL.�{✓ 1(�- -- <br /> ABOVE-GACUND CHRXTY-80X <br /> COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> Distance to server line Grout <br /> Domestic well on site - (y/ n ) �," ft. <br /> If yes, location and distance - ft- <br /> ft. <br /> «c• C <br /> SAMPLING � \���„ „n„ ® 3p�_Zq ' atorod ,•'. = C <br /> wr <br /> sscdcn <br /> Holding Temperature = <br /> Method— jko7f r_0 , = _ �'""9I Pack <br /> Screening Method AjbrSL <br /> Tracking Sheet - ( y _ <br /> SPOILS c p, <br /> Storage Method u a 1, ak- �x MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( /( ��� <br /> Storage Location Casing type <br /> Blank 25 ft. Screen 20 <br /> Slot size .010 <br /> GROUTING Bags cement Ill <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> S <br /> Mix Ratios � Filter Pack type/size L f(p <br /> Installation Method Surge Block: - (y/©) <br /> Quantity Installed 00-t Discussed with geologist: - (F,� n ) <br /> EH 29 29 Type of method <br />