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I <br /> ATORING WELL INSTALLATION REPORTS <br /> Date: q/712-o1l CONSTRUCTION <br /> Premise Address., o�/�7 �e 0/iSA^ �� Total Depth <br /> Screen Length (from)—(to)- <br /> Well <br /> from) (to)Well No.:—h S f Filter Pack (from) (to) <br /> y p Bentonite (from) (to) <br /> Inspector. s� eA40-e C Grout (from)—(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company. <br /> Driller: casing <br /> 1711 <br /> heightConsultant f11?C�/S -i- <br /> Geologistir <br /> ABOVEdaRCUND CHRISTY-BOX <br /> CONFL"ETpN COMPLEnON <br /> SPECIAL PERMIT INFO. Grourd Surtax <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> reg n. te.s n. <br /> O <br /> Y <br /> C <br /> SAMPLING tlorad — <br /> J' =_ C <br /> LLo siC�cn 3 <br /> Holding Temperature 7 C _ �� <br /> Pack <br /> Method `Qr,E¢YZ. <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS � L <br /> Storage Method ' MATERIALS/DEVELOPMENTT <br /> Contamination Noted - y n ) q <br /> Storage Location Casing type a r'UC. <br /> Blank ft. Screen ft. <br /> Slot size D.o/o <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water /6 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size ;L-/12-- <br /> Installation Method Surge Block: - ( y Alxi-) <br /> Quantity Installed Discussed with geologist: - (Cy->/ n ) <br /> Type of method <br /> EH 29 29 <br />