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CORING WELL INSTALLATION REPOROP <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from)—(to)— <br /> Inspector. <br /> from) (to)Inspector. Grout (from)-(to)— <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist �- <br /> ABOVE-GRCl1N0 CFffilSiY 80X <br /> CCh4�LET10N COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surfact <br /> Distance to sewer line grad <br /> Domestic well on site - (y/ n) " \ ✓ <br /> ft. <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> SAMPLING slorad = Y <br /> sacicn — <br /> Holding Temperature <br /> Method = <br /> Screening Method 2: _ <br /> Tracking Sheet - (y/ n ) t Ll i 13c �3 <br /> ft. ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />