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&IOMTORING WELL rNSTALLATION REPI"Z* <br /> Ckc'–tu <br /> Zv Z C� '1 '1�� 0 coNSTRuc-rloN <br /> Date: <br /> �a <br /> ?remise A ess: , 7� LL, CI Cc LL Total Depth <br /> / Screen Length (from) (to) <br /> Well No.: f I � /'� ��Z , 13 A.1� >> Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: <br /> Grout (570m) (to) <br /> Drilling rig type <br /> ?ermit No. Auger O.D. t.D. <br /> y C- Completion - Stove pipe/christie box (circle one) <br /> Drilling Company. (J C <br /> Driller. casLnq <br /> (� �f�� :eight <br /> Consultant / C I/ <br /> ^ r_ T <br /> UV <br /> Geologist 444 <br /> ABCVc--GRC JND <br /> CvtvPL'IGN drtFii.Sl^f_aCX <br /> C',.'YvIP'_i CN <br /> SPECIAL PERMIT INFO. Grm;nd S+facs <br /> Distance to sewer line Qraclt <br /> I <br /> Domestic well on site - ( y <br /> If,yes, location and distance IJ <br /> ft. i. <br /> w _ 3 <br /> v � a <br /> SAMPLING — <br /> tlottaC <br /> � <br /> Hold' � C�i <br /> 7XVW Pack <br /> Method <br /> Screening Method a �tSQ <br /> Tracking Sheer ( y n )Z <br /> tt. <br /> SPOILS <br /> r <br /> Storage Method `"Z � C MATERIALS/DEVELOPMENT <br /> Contaminarion Noted <br /> Storage Location do Casing type <br /> Blank n Screen n <br /> Slot size <br /> GROUTING �, /�J �41/r�n-�r Bags cement <br /> l Buckets bentonite <br /> Depth to water " Bags sand/gravel <br /> Mix Ratios Filter Pack typ e <br /> Installation Method Surge Block ( n ) <br /> Quantity Installed Discussed wi logisr. - / n ) <br /> Type of meth <br /> EH 29 29 <br /> Of <br />