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MOWTORING WELL INSTALLATION REPORT <br /> Date: I'S' CONSTRUCTION <br /> Premise Address: tJAU`� �� - ) Total Depth <br /> Screen Length (from) 46 (to) <br /> � <br /> Well No.: NA co bLi / oil Filter Pack (from) (to) �2 <br /> Bentonite (from) 22.'+ (to) <br /> Inspector. fk�i� Grout (from) ,Zl�_(to) <br /> L-{ Drilling rig type <br /> / <br /> Permit No. 01) 4� Auger O.D. 10" I. ' <br /> Completionn�Stove pip stie box icie one) <br /> Drilling Company: LU f3 ( c � <br /> Driller: casing <br /> height <br /> Consultantil� <br /> Geologist 01N <br /> AE; VE-GROUND CHRtm-aox <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line_ <D" f &10AA.Y - Qfout <br /> Domestic well on site - (y/ n) .ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING 30-36' CNILLft i ZMOL� sbro� <br /> &#cicn — <br /> HoIding Temperature _ Pack <br /> Method — gravel <br /> =� — <br /> Screening Method -- <br /> Tracking Sheet - (y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method U N tyles u �I, 2 U , MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/n) 1( P <br /> Storage Location IJ Casing e <br /> Blank 7 ft. Screen ZO ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to Ovate I Bags sand/gravel <br /> Mix Ratios 20RQS Filter Pack type/size <br /> Installation Metho6 Surge Block: - (y n <br /> Quantity Installed 6 -f' Discussed with geol gist: -((y n <br /> Type of method <br /> EH 29 29 <br />