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bu ORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Total Depth <br /> (frm) 5 tr ((ttoo)) <br /> oPremise Address: Screen Lngth <br /> " Filter Pack (from) <br /> - <br /> Well No.: a�T3 <br /> , <br /> _ <br /> Bentonite (from) 3- (to) <br /> Grout (from) `_ (to ) /mac✓� <br /> Inspector. DrMing rig type haL — <br /> Auger O.D. <br /> I.D. <br /> Permit No. Completion - Stove pipe/ a (circle one) <br /> Drilling Company: <br /> casing <br /> Driller. —� height , <br /> Consultant__ 0 p rill <br /> Geologist CHFi1bTf-30X <br /> G=nd Sufi <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sever lineIt. <br /> Domesric well on site - (y/ n ) <br /> FV//", <br /> If yes, location and distance - ft. <br /> 1 _ <br /> a <br /> O <br /> SAMPLING <br /> Holding Temperature <br /> Method <br /> Screeninv Method P uJ 7 <br /> I racking Sheet - (Y/ n ) LA <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted- C— <br /> Storage Location zoo ' Casing type ft. <br /> Blank � ft. Screen <br /> Slot size r b a - <br /> GROUTINGBags cement <br /> 1_ , 3� r Puckers bentonite <br /> Depth to water <br /> f {� 2 ,S Bags sand/gravel <br /> Mix Rados Filter Pack We/size /1 �c <br /> Installation Method Surge Block. - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />