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MC �"ORING WELL INSTALLATION REPORT <br /> Date: —� CONSTRUCTION <br /> Premise Address: ��� 7 �i Total Depth ? <br /> Screen Length (from) (to) 13 <br /> Well No.: f T/ Filter Pack (from) Z (to) /f <br /> Bentonite (from) (to) <br /> Inspector: Grout (fro (to) <br /> / Drilling rig type FZ <br /> 7 <br /> Permit No. Auger O.D. I.D. (a <br /> r /P C Completion - Stove pipe/chrsrie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller. <br /> height <br /> Consultant <br /> 6�- e94-ltl�— <br /> Geologist //?l A3OvE-GROUND <br /> CJhi�L�10N CNAIS'TY-30X <br /> C .ci N <br /> Ground Strfacs <br /> SPECIAL PErMT INFO. <br /> 9t�Z <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) tL <br /> If yes, location and distance - l �' <br /> t3 n, <br /> -r.: _ <br /> slotwd �: — <br /> SAMPLING aacion <br /> ..a• ;W� . <br /> Holding Temperature �' r <br /> Method Ok <br /> Screening Method ' <br /> Tracking Sheet - `y n) 24 n• <br /> SPOILS <br /> Storage Method ©X t u4a'e'c �9 MATERIALS/DEVELOPMENT <br /> Contamination Noted O�� <br /> Storage Location 61 e Casing type <br /> Blank / ft. Screen l5 fG <br /> Sloc size - OzC) <br /> GROUPING ° Bags cement 3 _ <br /> Bucket tonite ! ¢a_ <br /> Depth to water �/ Bag sand/ <br /> Mix Rados S Filter ack type/size L• s <br /> Installation Method Surge Bloch: -� n) <br /> Quantiry Installed 27e.R tea.. wry Q Discussed with geologist: - y n <br /> 110 C— A_l / Q3 Type of method <br /> 1, <br />